Author: Anisha Valli

Diagnosis Demystified – Case 24

Anisha ValliLeave a comment

A 56-year-old woman complains of a burning sensation affecting her tongue. It is present on a more or less continuous basis and gets worse as the day goes on. Her GP prescribed a mouthwash for her but this has not been of any benefit. She is edentulous but leaving her dentures out makes no difference to the pain. Her medical history is unremarkable and, on examination, her tongue appears completely normal. What is the diagnosis? Click on below link to find out the answer

Hey, guys! 🙋‍♀️ So, there’s this 56-year-old lady, and she’s like, “My tongue feels like it’s on fire 🔥 all the time, ugh!” Her GP gave her this lame mouthwash, but it’s like, zero help. 🙅‍♀️ Like, why even bother, right? She doesn’t even have teeth, and guess what? Taking out her dentures doesn’t make a dang difference to the pain! 😬 Her medical history is all chill, and when they checked her tongue, it’s totally normal. 🤷‍♀️ So, what could be causing this burning sensation? It’s like a mystery, y’all! 🕵️‍♀️

So, like, if you’re on the same page as me, you’re probably DYING to know the diagnosis, right?! I gotchu covered! Just click on the link below to reveal the big answer! 🕵️‍♀️

Alright, brace yourselves for the big reveal! 🥁 drumroll, please 🥁 The diagnosis is… (wait for it) … Burning Mouth Syndrome (BMS)! 🙌 Yeah, you heard me right! It’s this condition where you feel this burning sensation in your mouth, but there’s no apparent cause! 😵

I know, I know, it’s like, totally insane! 😜 But BMS is for real, yo! It’s this mysterious thing that can happen to anyone, even if they don’t have teeth! 🦷 It’s like your taste buds are throwing a party, but instead of fun, it’s just burning vibes. 🔥 And it’s not just her, peeps! Lots of people deal with this, and it can be super frustrating! 😤

So, even though her mouth looks fine, she’s stuck with this annoying burning sensation. 🙅‍♀️ But don’t worry, she’s not alone! There are ways to manage this crazy BMS beast, like staying away from spicy foods or acidic stuff that can make it worse. 😓

RESEARCH

Burning Mouth Syndrome (BMS) is a chronic oral pain disorder characterized by a burning sensation in the mouth without any specific mucosal lesions (Kim et al., 2020). It is more common in women, particularly in the fourth to sixth decades of life (Scardina et al., 2010). The exact cause of BMS is still unknown, but it has been associated with various factors such as psychoneurological conditions, peripheral nerve atrophy in the tongue epithelium, and psychosocial events (Kim et al., 2020).

Several studies have reported an increased prevalence of psychiatric symptoms and psychological disorders in patients with BMS, including depression and anxiety (Kim et al., 2020). In a population-based cohort study conducted in South Korea, it was found that patients with BMS had a higher risk of developing depression and anxiety compared to individuals without BMS (Kim et al., 2020). The adjusted hazard ratios for the development of depression and anxiety were 2.77 and 2.42, respectively (Kim et al., 2020).

In addition to psychiatric symptoms, BMS has also been associated with other chronic pain syndromes, such as other idiopathic orofacial pain and central sensitivity syndromes (Moisset et al., 2016). This suggests that BMS may share common mechanisms with other chronic pain conditions (Moisset et al., 2016).

Treatment options for BMS are limited and there is no gold-standard treatment available (Çinar et al., 2018). However, various approaches have been explored. One study evaluated the efficacy of a topical capsaicin rinse in improving the symptoms of BMS and found it to be useful in treating the discomfort associated with BMS (Silvestre et al., 2012). Another study investigated the effectiveness and safety of clonazepam, pregabalin, and alpha-lipoic acid for treating BMS and found that systemic clonazepam and pregabalin were viable options for treatment (Çinar et al., 2018). Acupuncture has also been suggested as a therapeutic possibility for BMS (Scardina et al., 2010).

In conclusion, BMS is a chronic oral pain disorder characterized by a burning sensation in the mouth. It is associated with an increased risk of developing psychoneurological conditions, such as depression and anxiety. The exact cause of BMS is still unknown, but it has been linked to peripheral nerve atrophy, psychosocial events, and other chronic pain syndromes. Treatment options for BMS are limited, but topical capsaicin, systemic clonazepam, pregabalin, and alpha-lipoic acid have shown promise in improving symptoms. Further research is needed to better understand the etiology and develop more effective treatments for BMS.

REFERENCES

Kim, Y., Ko, I., Kim, D. (2020). Association Between Burning Mouth Syndrome and The Development Of Depression, Anxiety, Dementia, And Parkinson Disease. JAMA Otolaryngol Head Neck Surg, 6(146), 561. https://doi.org/10.1001/jamaoto.2020.0526 Moisset, X., Calbacho, V., Torres-Martínez, P., Gremeau-Richard, C., Dallel, R. (2016). Co-occurrence Of Pain Symptoms and Somatosensory Sensitivity In Burning Mouth Syndrome: A Systematic Review. PLoS ONE, 9(11), e0163449. https://doi.org/10.1371/journal.pone.0163449 Scardina, G., Ruggieri, A., Provenzano, F., Messina, P. (2010). Burning Mouth Syndrome: Is Acupuncture a Therapeutic Possibility?. Br Dent J, 1(209), E2-E2. https://doi.org/10.1038/sj.bdj.2010.582 Silvestre, F., Silvestre-Rangil, J., Tamarit-Santafé, C., Bautista, D. (2012). Application Of a Capsaicin Rinse In The Treatment Of Burning Mouth Syndrome. Med Oral, e1-e4. https://doi.org/10.4317/medoral.17219 Çinar, S., Kartal, D., Pergel, T., Borlu, M. (2018). Effectiveness and Safety Of Clonazepam, Pregabalin, And Alpha Lipoic Acid For The Treatment Of Burning Mouth Syndrome. Erciyes Med J, 35-38. https://doi.org/10.5152/etd.2018.17160

Comparative evaluation of postoperative pain following chemomechanical preparation of single-rooted nonvital teeth with symptomatic apical periodontitis with and without laser irradiation

Anisha ValliLeave a comment

Hey, peeps! 🌟 Let’s talk about postoperative pain in those endodontic procedures! 😫 Ouch, right? But guess what? There are some cool ways to reduce that pain! 🙌💙 One factor is how they clean and shape those root canals – it can release irritants and cause inflammation! 🔍😓 But fear not, studies have looked into different techniques to make it less painful! 😎 Like keeping the apical patency during the cleaning process – it didn’t make a big difference in pain! 🚫🦷 And using laser irradiation as an add-on – whoa, it actually helped reduce post-op pain! 🔥💡 Even the form of sodium hypochlorite (NaOCI) they use matters! But whether it’s gel or solution, post-op pain is kinda similar! 🤷‍♀️💦 Also, the size of apical preparation – it didn’t affect pain much either! 😅🔄 So, it’s like a puzzle, fam! There’s no one-size-fits-all solution, and they need to pick the best pain relief for each case! 🧩💊

Postoperative pain is a common concern in endodontic procedures, and various factors can contribute to its occurrence. One important factor is the chemomechanical preparation of the root canals, which can lead to the release of irritants and induce an acute inflammatory response in periapical tissues (Machado et al., 2022; Uysal et al., 2022; Adigüzel et al., 2019). The presence of residual infection after chemomechanical preparation can also contribute to postoperative pain (Shivangi et al., 2022). Therefore, it is crucial to evaluate different techniques and adjuncts that can potentially reduce postoperative pain in endodontic procedures.

One study compared the effect of maintaining apical patency during chemomechanical preparation on postoperative pain in posterior teeth with necrotic pulps and apical periodontitis. The study found that maintaining apical patency had no significant influence on postoperative pain in these cases (Arora & Duhan, 2015). Another study compared the postoperative pain intensity after using reciprocating and continuous rotary glide path systems for glide path preparation. The study found that there was no significant difference in postoperative pain intensity between the two systems (Adigüzel et al., 2019).

Laser irradiation has also been investigated as an adjunct to reduce postoperative pain in endodontic procedures. A double-blind randomized placebo-controlled clinical trial compared postoperative pain following chemomechanical preparation with and without laser irradiation in nonvital teeth with symptomatic apical periodontitis. The study found that laser irradiation led to a significant reduction in postoperative pain (Machado et al., 2022; Shivangi et al., 2022).

The form of sodium hypochlorite (NaOCI) used during chemomechanical preparation has also been studied in relation to postoperative pain. A randomized clinical trial compared the effect of using gel and solution forms of NaOCI on postoperative pain. The study found that the use of the gel form of NaOCI showed similar postoperative pain compared to the solution form (Özlek et al., 2021).

Furthermore, the size of apical preparation has been investigated in relation to postoperative pain. One study evaluated postoperative pain after endodontic treatment of necrotic teeth submitted to large apical preparation using oscillatory kinematics. The study found no significant difference in postoperative pain between teeth with and without large apical preparation (Machado et al., 2022; Machado et al., 2021).

In addition to the techniques and adjuncts used during chemomechanical preparation, the choice of analgesics can also affect postoperative pain. A study compared local and systemic ibuprofen for the relief of postoperative pain in symptomatic teeth with apical periodontitis. The study aimed to determine the most effective method for relieving postoperative pain due to chemomechanical preparation (Uysal et al., 2022).

Overall, the management of postoperative pain in endodontic procedures is a multifactorial process. Factors such as the technique and adjuncts used during chemomechanical preparation, the form of irrigants, the size of apical preparation, and the choice of analgesics can all influence postoperative pain. It is important for clinicians to consider these factors and tailor their approach to each individual case to minimize postoperative pain and improve patient comfort.

REFERENCES

Adigüzel, M., Yılmaz, K., Tufenkci, P. (2019). Comparison Of Postoperative Pain Intensity After Using Reciprocating and Continuous Rotary Glide Path Systems: A Randomized Clinical Trial. Restor Dent Endod, 1(44). https://doi.org/10.5395/rde.2019.44.e9 Arora, M., Duhan, J. (2015). Effect Of Maintaining Apical Patency On Endodontic Pain In Posterior Teeth With Pulp Necrosis and Apical Periodontitis: A Randomized Controlled Trial. Int Endod J, 4(49), 317-324. https://doi.org/10.1111/iej.12457 García-Font, M., Duran-Sindreu, F., Calvo, C., Basilio, J., Abella, F., Ali, A., … & Olivieri, J. (2017). Comparison Of Postoperative Pain After Root Canal Treatment Using Reciprocating Instruments Based On Operator’s Experience: a Prospective Clinical Study. J Clin Exp Dent, 0-0. https://doi.org/10.4317/jced.54037 Machado, R., Comparin, D., Ignácio, S., Mx, N. (2022). Postoperative Pain After Endodontic Treatment Of Necrotic Teeth Submitted To Large Apical Preparation Using Oscillatory Kinematics. J Clin Exp Dent, e158-e167. https://doi.org/10.4317/jced.58726 Machado, R., Comparin, D., Ignácio, S., Neto, U. (2021). Postoperative Pain After Endodontic Treatment Of Necrotic Teeth With Large Intentional Foraminal Enlargement. Restor Dent Endod, 3(46). https://doi.org/10.5395/rde.2021.46.e31 Opacic-Galic, V., Zivkovic, S. (2011). Postoperative Pain After Primary Endodontic Treatment and Retreatment Of Asimptomatic Teeth. SERBIAN DENT J, 2(58), 75-81. https://doi.org/10.2298/sgs1102075p Shivangi, S., Rao, R., Jain, A., Verma, M., Guha, A., Langade, D. (2022). Comparative Evaluation Of Postoperative Pain Following Chemomechanical Preparation Of Single-rooted Nonvital Teeth With Symptomatic Apical Periodontitis With and Without Laser Irradiation: A Double-blind Randomized Placebo Controlled Clinical Trial. J Conserv Dent, 6(25), 610. https://doi.org/10.4103/jcd.jcd_276_22 Uysal, İ., Eratilla, V., Topbaş, C., Çelik, Y. (2022). Comparison Of Local and Systemic Ibuprofen For Relief Of Postoperative Pain In Symptomatic Teeth With Apical Periodontitis. Med Sci Monit, (28). https://doi.org/10.12659/msm.937339 Özlek, E., Gunduz, H., Kadi, G., Tasan, A., Akkol, E. (2021). The Effect Of Solution and Gel Forms Of Sodium Hypochlorite On Postoperative Pain: A Randomized Clinical Trial. J. Appl. Oral Sci., (29). https://doi.org/10.1590/1678-7757-2020-0998

Diagnosis Demystified – Case 23

Anisha ValliLeave a comment

An 80-year-old woman who moved into residential care 3 months ago is brought to your surgery. The elderly lady is complaining of an intense burning sensation affecting the right-hand side of her face which has been present for at least the past 3 months. The lower part of her face is spared. Nothing seems to make it better or worse. The patient is a poor historian and the carer knows little of her history before she came to live at the care home. On examination, you notice some scarring on the skin of her right cheek and forehead but nil else of note. The patient was recently prescribed a low dose of amitriptyline for anxiety by her GP and this seems to have helped a little with the pain.

Hey, fam! 🌟 Let’s break down this medical mystery in a way we can all understand! 🤓 So, we’ve got this sweet 80-year-old lady in a care home dealing with intense face pain on the right side! 😫 It’s been going on for 3 months, and nothing seems to make it better or worse. 😕 She’s a bit forgetful, but her carer noticed some scars on her right cheek and forehead. 🧐 Plus, she’s taking amitriptyline for anxiety, which kinda helps with the pain! 🙌 So what’s going on?

Some clues point to atypical facial pain – constant pain, no triggers, and a little help from amitriptyline! 🤔 But wait, there’s more – the pain’s got a specific spot, not touching the area of the trigeminal nerve! 🙅‍♀️ And that intense burning sensation? It screams postherpetic neuralgia! 🔥 The scarring on her face hints at previous herpes zoster – that’s a big clue! 📝 So, what’s the final verdict? 🤷‍♀️ Let’s put all the pieces together – atypical facial pain with a sprinkle of postherpetic neuralgia! 💥💔 We’ve cracked the case, fam! But stay tuned for more medical adventures! 🚀💙

RESEARCH

Atypical facial pain (AFP) is a type of facial pain that is characterized by persistent or recurrent pain in the face that does not fit the typical patterns of other facial pain syndromes such as trigeminal neuralgia (Koopman et al., 2009). It is considered a rare condition, but its exact incidence in the general population is not well established (Koopman et al., 2009). However, studies have shown that AFP is more common in women than men (Koopman et al., 2009).

Postherpetic neuralgia (PHN) is another type of facial pain that can occur after an episode of herpes zoster (shingles) (Koopman et al., 2009; Tolba et al., 2019). It is characterized by persistent pain in the area where the shingles rash occurred, even after the rash has healed (Tolba et al., 2019). The incidence of PHN has been studied in the general population, and it has been found to be relatively rare (Koopman et al., 2009). However, it is important to note that PHN can cause significant distress and compromise the quality of life for those affected (Jeon, 2016).

The diagnosis of AFP and PHN can be challenging, as there are no specific tests or imaging studies that can definitively confirm these conditions (Koopman et al., 2009). Diagnosis is typically based on clinical evaluation, medical history, and exclusion of other possible causes of facial pain (Koopman et al., 2009). In some cases, additional diagnostic procedures such as quantitative sensory testing or nerve blocks may be performed to aid in the diagnosis (Okayasu et al., 2014).

Treatment options for AFP and PHN vary depending on the severity and individual patient characteristics. Conservative management approaches may include medications such as anticonvulsants, antidepressants, and analgesics to help manage pain (Tolba et al., 2019; Akbaş et al., 2016). In some cases, interventional procedures such as sphenopalatine ganglion block, radiofrequency ablation, or neurostimulation may be considered (Ho et al., 2017; Tolba et al., 2019; Jeon, 2016). Surgical interventions, such as trigeminal tractotomy-nucleotomy or dorsal root entry zone operations, may be reserved for refractory cases (Bekar et al., 2020; Kanpolat et al., 2008).

Overall, AFP and PHN are distinct facial pain conditions that can significantly impact the quality of life of affected individuals. Accurate diagnosis and appropriate management are essential for providing relief and improving the well-being of patients experiencing these conditions. Further research is needed to better understand the incidence, etiology, and optimal treatment strategies for AFP and PHN.

Ozone: An Adjunct in Dental Treatment

Anisha ValliLeave a comment

Ozone therapy has gained attention in the field of dentistry as a potential adjunct treatment for various dental conditions. Ozone, a colorless gas with a characteristic odor, has been shown to have antimicrobial, disinfectant, biocompatibility, and healing properties (Naik et al., 2016). It is being explored as a potential atraumatic, biologically-based treatment for conditions encountered in dental practice (Nogales et al., 2008). Ozone therapy has been used in dentistry for a range of applications, including the prevention and management of dental caries, teeth remineralization, control of infection, disinfection of periodontal pockets, teeth bleaching, management of pain, biofilm removal, enhancement of healing, tissue regeneration, and control of halitosis (Mostafa & Zakaria, 2018).

One of the advantages of ozone therapy is its antimicrobial effect. Ozone has been found to have a rapid microbicidal effect on oral microorganisms in pure culture (Nagayoshi et al., 2004). It has been shown to kill oral microorganisms at a concentration of 2-4 mg/l (Nagayoshi et al., 2004). Ozone has also been found to be effective in disinfecting medical instruments and similar equipment (Baysan et al., 2000). It can be used as a soaking solution for dental instruments (Nagayoshi et al., 2004). Ozone therapy has been proposed as an alternative non-medication therapy for the management of oral lichen planus (Mostafa & Zakaria, 2018). It has also shown success in managing wound healing, gingivitis, periodontitis, osteonecrosis of the jaw, and dentin hypersensitivity (Suh et al., 2019).

In addition to its antimicrobial properties, ozone therapy has been found to have anti-inflammatory effects. Locally applied ozone has been shown to alleviate painful conditions and reduce inflammatory responses (AL-Omiri et al., 2018). Ozone therapy has been explored for its potential to improve the healing of infected wounds, necrotic or poorly oxygenated tissue, and facial nerve regeneration (Özbay et al., 2017). It has also been studied for its potential to enhance the healing of peri-implant mucositis and promote tissue repair in periapical lesions (Butera et al., 2023; Silva et al., 2022).

The use of ozone therapy in dentistry is still evolving, and more research is needed to establish safe and well-defined parameters for its use. Randomized controlled trials are necessary to determine the precise indications and guidelines for ozone therapy in dental practice (Nogales et al., 2008). Despite its potential benefits, the application of ozone therapy in dentistry is limited due to possible side effects (Naik et al., 2016). Therefore, dental practitioners need to have a proper understanding of ozone therapy and its proper usage to provide better patient care and reduce the time and cost of treatment (Naik et al., 2016).

In conclusion, ozone therapy has shown potential as an adjunct treatment in dental practice. It has antimicrobial, disinfectant, anti-inflammatory, and healing properties that make it a promising option for various dental conditions. However, further research is needed to establish safe and well-defined parameters for its use in dental practice. Dental practitioners should stay updated with the latest evidence and guidelines regarding ozone therapy to provide optimal care to their patients.

REFERENCES

AL-Omiri, M., Nazeh, A., Kielbassa, A. (2018). Randomized Controlled Clinical Trial On Bleaching Sensitivity and Whitening Efficacy Of Hydrogen Peroxide Versus Combinations Of Hydrogen Peroxide And Ozone. Sci Rep, 1(8). https://doi.org/10.1038/s41598-018-20878-0 AlMogbel, A., Albarrak, M., AlNumair, S. (2023). Ozone Therapy In the Management And Prevention Of Caries. Cureus. https://doi.org/10.7759/cureus.37510 Anzolin, A., Silveira-Kaross, N., Bertol, C. (2020). Ozonated Oil In Wound Healing: What Has Already Been Proven?. Med Gas Res, 1(10), 54. https://doi.org/10.4103/2045-9912.279985 Barczyk, I., Masłyk, D., Walczuk, N., Kijak, K., Skomro, P., Gronwald, H., … & Lietz-Kijak, D. (2023). Potential Clinical Applications Of Ozone Therapy In Dental Specialties—a Literature Review, Supported By Own Observations. IJERPH, 3(20), 2048. https://doi.org/10.3390/ijerph20032048 Baysan, A., Whiley, R., Lynch, E. (2000). Antimicrobial Effect Of a Novel Ozone– Generating Device On Micro–organisms Associated With Primary Root Carious Lesions In Vitro. Caries Res, 6(34), 498-501. https://doi.org/10.1159/000016630 Butera, A., Pascadopoli, M., Gallo, S., Martínez, C., Val, J., Parisi, L., … & Scribante, A. (2023). Ozonized Hydrogels Vs. 1% Chlorhexidine Gel For the Clinical And Domiciliary Management Of Peri-implant Mucositis: A Randomized Clinical Trial. JCM, 4(12), 1464. https://doi.org/10.3390/jcm12041464 Grillo, R., Campos, F., Jodas, C. (2022). Alternative Approach To Treating Dark Circles: a Case Report. J of Cosmetic Dermatology, 12(21), 6909-6912. https://doi.org/10.1111/jocd.15349 Jain, M., Mishra, R., Mishra, R., Ghritlahare, H., Pathak, A., Shukla, S. (2021). Ozone Therapy-new Innovation In Dentistry. ijhs, 444-452. https://doi.org/10.53730/ijhs.v5ns2.5866 Kazancioglu, H., Ezirganli, S., Demirtaş, N. (2013). Comparison Of the Influence Of Ozone And Laser Therapies On Pain, Swelling, And Trismus Following Impacted Third-molar Surgery. Lasers Med Sci, 4(29), 1313-1319. https://doi.org/10.1007/s10103-013-1300-y Marconcini, S. (2023). The Effect Of Ozonized Water Irrigation In the Circuits Of Professional Ultrasonic Scalers For Causal Therapy Of Stage I Periodontitis: A Randomized Clinical Study. J Dent Hyg Sci, 1(23), 13-19. https://doi.org/10.17135/jdhs.2023.23.1.13 Meira, A., Santos, A., Lima, C., Milhomens, F., Araujo-Silva, G., Cardoso, M., … & Filho, J. (2022). Use and Applicability Of Ozone Therapy In Clinical Practice In Dentistry: An Integrative Review. Int. J. Odontostomat., 4(16), 468-474. https://doi.org/10.4067/s0718-381×2022000400468 Mithun, D., Moses, J., Sharanya, N. (2022). Ozone Therapy In Management and Prevention Of Dental Caries- A Review. IJPedoR, 2(7), 25-29. https://doi.org/10.56501/intjpedorehab.v7i2.579 Mostafa, B., Zakaria, M. (2018). Evaluation Of Combined Topical Ozone and Steroid Therapy In Management Of Oral Lichen Planus. Open Access Maced J Med Sci, 5(6), 879-884. https://doi.org/10.3889/oamjms.2018.219 Mousa, H. (2023). Clinical and Radiographic Evaluation Of Ozone Therapy In Odontectomy Of Impacted Mandibular Third Molar. Int. J. Appl. Dent. Sci., 1(9), 307-311. https://doi.org/10.22271/oral.2023.v9.i1e.1697 Nagayoshi, M., Fukuizumi, T., Kitamura, C., Yano, J., Terashita, M., Nishihara, T. (2004). Efficacy Of Ozone On Survival and Permeability Of Oral Microorganisms. Oral Microbiol Immunol, 4(19), 240-246. https://doi.org/10.1111/j.1399-302x.2004.00146.x Naik, S., Rajeshwari, K., Kohli, S., Zohabhasan, S., Bhatia, S. (2016). Ozone- a Biological Therapy In Dentistry- Reality Or Myth?????. TODENTJ, 1(10), 196-206. https://doi.org/10.2174/1874210601610010196 Nogales, C., Ferrari, P., Kantorovich, E., Lage-Marques, J. (2008). Ozone Therapy In Medicine and Dentistry. The Journal of Contemporary Dental Practice, 4(9), 75-84. https://doi.org/10.5005/jcdp-9-4-75 Roth, A., Maruthamuthu, M., Nejati, S., Krishnakumar, A., Selvamani, V., Sedaghat, S., … & Rahimi, R. (2022). Wearable Adjunct Ozone and Antibiotic Therapy System For Treatment Of Gram-negative Dermal Bacterial Infection. Sci Rep, 1(12). https://doi.org/10.1038/s41598-022-17495-3 Rusdy, H. (2023). The Disinfection Effectiveness Of Ozone Water and 4.8% Chloroxylenol Against The Number Of Bacterial Colonies In Dental Extraction Instruments At The Usu Dental And Oral Hospital In October-december 2022. F1000Res, (12), 726. https://doi.org/10.12688/f1000research.132941.1 Saini, R. (2011). Ozone Therapy In Dentistry: a Strategic Review. J Nat Sc Biol Med, 2(2), 151. https://doi.org/10.4103/0976-9668.92318 Sen, S., Sen, S. (2020). Ozone Therapy a New Vista In Dentistry: Integrated Review. Med Gas Res, 4(10), 189. https://doi.org/10.4103/2045-9912.304226 Silva, E., Morais, B., Vivacqua, F. (2022). Association Of Ozoniotherapy To Endodontics, Aiming At the Tissue Repair Of Periapical Lesions – A Literature Review / Associação Da Ozonioterapia à Endodontia, Visando O Reparo Tecidual De Lesões Periapicais – Uma Revisão De Literatura. BASR, 4(6), 1292-1304. https://doi.org/10.34115/basrv6n4-005 Srikanth, A., Sathish, M., Harsha, A. (2013). Application Of Ozone In the Treatment Of Periodontal Disease. J Pharm Bioall Sci, 5(5), 89. https://doi.org/10.4103/0975-7406.113304 Suh, Y., Patel, S., Kaitlyn, R., Gandhi, J., Joshi, G., Smith, N., … & Khan, S. (2019). Clinical Utility Of Ozone Therapy In Dental and Oral Medicine. Med Gas Res, 3(9), 163. https://doi.org/10.4103/2045-9912.266997 Özbay, İ., Ital, I., Kucur, C., Akcılar, R., Deger, A., Aktas, S., … & Oghan, F. (2017). Effects Of Ozone Therapy On Facial Nerve Regeneration. Brazilian Journal of Otorhinolaryngology, 2(83), 168-175. https://doi.org/10.1016/j.bjorl.2016.02.009

Diagnosis Demystified – Case 22

Anisha ValliLeave a comment

A 65-year-old woman presents with a throbbing pain affecting her left temple. The headache began about a week ago and is accompanied by pain in the muscles around her jaw joint on eating. She has no previous history of facial pain or headache. Intraoral examination is unremarkable. There is no evidence of dental pathology or parafunctional habits.

The recent onset of unilateral pain of this nature in this site without any previous history should immediately raise the possibility of giant-cell arteritis. The patient is in the right age group (usually = 50 years). The accompanying pain in the muscles of mastication on chewing could represent temporomandibular joint dysfunction but is entirely consistent with giant-cell arteritis.

RESEARCH

Giant-cell arteritis (GCA), also known as temporal arteritis or Horton’s arteritis, is a systemic vasculitis that primarily affects large and medium-sized vessels, particularly the extracranial branches of the carotid arteries (Calvo-Romero, 2003). It is most commonly observed in individuals over the age of 50 (Joseph et al., 2019). GCA is characterized by inflammation of the blood vessels, which can lead to various symptoms and complications (Shenoy et al., 2023).

The diagnosis of GCA can be challenging, and early recognition is crucial to prevent serious complications such as blindness, stroke, and necrosis of the lips and tongue (Gualtierotti et al., 2018). The diagnosis of GCA is typically based on a combination of clinical features, laboratory tests, and imaging studies (Liedtke et al., 2023). The gold standard for diagnosis is a temporal artery biopsy, which reveals histologic evidence of arteritis (Bengtsson & Malmvall, 1981). However, it is important to note that giant cells are not required in the histopathological diagnostic criteria for GCA (Armstrong et al., 2008).

The symptoms of GCA can vary but commonly include severe temporal headaches, low-grade fever, malaise, depression, weight loss, and visual changes (Gualtierotti et al., 2018). Patients may also experience dental pain, dysphagia, dysarthria, chronic cough, and, rarely, necrosis of the lips and tongue (Gualtierotti et al., 2018). In some cases, GCA can present with orofacial symptoms such as toothache and pain/difficulty in chewing, which may lead patients to seek dental care initially (Shenoy et al., 2023).

Dentists play a crucial role in the early recognition and referral of patients with suspected GCA. Increased awareness of GCA among dental practitioners can minimize the risk of serious complications such as blindness and stroke (Shenoy et al., 2023). Dental practitioners should be alert to the possibility of GCA and should direct suspected cases to their general medical practitioner or a hospital specialist (Shenoy et al., 2023).

The management of GCA typically involves high-dose steroid treatment (Calvo-Romero, 2003). Early initiation of treatment is essential to prevent complications and improve outcomes (Lee et al., 2011). However, many questions about the diagnosis, treatment, and optimal patient follow-up of GCA remain unanswered (Iudici et al., 2023). International guidelines exist, but some aspects are based mainly on low-quality data or expert opinion (Iudici et al., 2023). The management of GCA patients can also be influenced by factors such as the care setting, physician’s experience, or resource availability (Iudici et al., 2023).

In conclusion, GCA is a systemic vasculitis that primarily affects large and medium-sized vessels. It can present with a wide range of symptoms, including orofacial symptoms such as dental pain and difficulty in chewing. Early recognition and referral of suspected cases are crucial to prevent serious complications. Dentists play an important role in the early detection of GCA and should be aware of the signs and symptoms associated with the condition. Further research is needed to improve the diagnosis, treatment, and management of GCA patients.

REFERENCES

Alimohammadi, M., Knight, A. (2013). Scalp Necrosis As a Late Sign Of Giant-cell Arteritis. Case Reports in Immunology, (2013), 1-2. https://doi.org/10.1155/2013/231565 Antonelli, J., Hottel, T. (2003). Oral Manifestations Of Renal Osteodystrophy: Case Report and Review Of The Literature. Special Care in Dentistry, 1(23), 28-34. https://doi.org/10.1111/j.1754-4505.2003.tb00286.x Armstrong, A., Tyler, W., Wood, G., Harrington, T. (2008). Clinical Importance Of the Presence Of Giant Cells In Temporal Arteritis. Journal of Clinical Pathology, 5(61), 669-671. https://doi.org/10.1136/jcp.2007.049049 Bajko, Z., Balasa, R., Maier, S., Motataianu, A., Barcutean, L., Andone, S., … & Filep, R. (2021). Stroke Secondary To Giant‑cell Arteritis: a Literature Review. Exp Ther Med, 2(22). https://doi.org/10.3892/etm.2021.10308 Bengtsson, B., Malmvall, B. (1981). The Epidemiology Of Giant Cell Arteritis Including Temporal Arteritis and Polymyalgia Rheumatica. Arthritis & Rheumatism, 7(24), 899-904. https://doi.org/10.1002/art.1780240706 Calvo-Romero, J. (2003). Giant Cell Arteritis. Postgraduate Medical Journal, 935(79), 511-515. https://doi.org/10.1136/pmj.79.935.511 Elad, S., Zadik, Y., Caton, J., Epstein, J. (2019). Oral Mucosal Changes Associated With Primary Diseases In Other Body Systems. Periodontol 2000, 1(80), 28-48. https://doi.org/10.1111/prd.12265 Gualtierotti, R., Marzano, A., Spadari, F., Cugno, M. (2018). Main Oral Manifestations In Immune-mediated and Inflammatory Rheumatic Diseases. JCM, 1(8), 21. https://doi.org/10.3390/jcm8010021 Iudici, M., Hemmig, A., Stegert, M., Courvoisier, C., Adler, S., Becker, M., … & Group, N. (2023). Management Of Giant-cell Arteritis In Switzerland: An Online National Survey. Swiss Med Wkly, 4(153), 40051. https://doi.org/10.57187/smw.2023.40051 Joseph, A., Pradeepan, J., Kumanan, T., Malaravan, M. (2019). Combined Left Central Retinal Artery Occlusion and Bilateral Anterior Ischemic Optic Neuritis: A Rare Presentation Of Giant Cell Arteritis. Case Reports in Rheumatology, (2019), 1-3. https://doi.org/10.1155/2019/3236821 Kawamoto, T., Ogasawara, M., Nakano, S., Matsuki−Muramoto, Y., Matsushita, M., Yamanaka, K., … & Tamura, N. (2019). Diagnosis Of Giant Cell Arteritis By Head-contrast Three-dimensional Computed Tomography Angiography: Two Case Reports. J Med Case Reports, 1(13). https://doi.org/10.1186/s13256-019-2199-0 Lee, Y., Padera, R., Noss, E., Fossel, A., Bienfang, D., Liang, M., … & Docken, W. (2011). Clinical Course and Management Of A Consecutive Series Of Patients With “Healed Temporal Arteritis”. J Rheumatol, 2(39), 295-302. https://doi.org/10.3899/jrheum.110317 Liedtke, F., Daher, I., Moura, M., Murad, A., Ferrari, R., Neiva, E., … & Souza, P. (2023). Clinical Evidence and Diagnosis Of Temporal Arteritis: A Concise Systematic Review. MedNEXT, 2(4). https://doi.org/10.54448/mdnt23203 Lim, Z., Sharp, C. (2021). Neck Swelling and Airway Narrowing As An Initial Manifestation Of Giant Cell Arteritis. BMJ Case Rep, 3(14), e237743. https://doi.org/10.1136/bcr-2020-237743 Mahe, E., Demellawy, D., Bane, A., Alowami, S. (2012). Giant Cell Temporal Arteritis Associated With Overlying Basal Cell Carcinoma: Co-incidence or Connection?. Rare Tumors, 3(4), 148-149. https://doi.org/10.4081/rt.2012.e46 McDonald, L., Baker, G., Kerr, O. (2019). Scalp Ulceration: a Rare Manifestation Of Giant Cell Arteritis. BMJ Case Rep, 11(12), e230795. https://doi.org/10.1136/bcr-2019-230795 Nayar, A., Casciello, M., Slim, J., Slim, A. (2013). Fatal Aortic Dissection In a Patient With Giant Cell Arteritis: A Case Report And Review Of The Literature. Case Reports in Vascular Medicine, (2013), 1-4. https://doi.org/10.1155/2013/590721 Nitta, S., Tanaka, T., Yanagihashi, R., Nonaka, H., Suzuki, S., Kimura, T., … & Nishiyama, H. (2021). Granulocyte Colony‐stimulating Factor Associated Arteritis In a Patient With Castration‐resistant Prostate Cancer. IJU Case Reports, 1(5), 29-31. https://doi.org/10.1002/iju5.12376 Regezi, J. (2002). Odontogenic Cysts, Odontogenic Tumors, Fibroosseous, and Giant Cell Lesions Of The Jaws. Modern Pathology, 3(15), 331-341. https://doi.org/10.1038/modpathol.3880527 Schmidt, W. (2006). Takayasu and Temporal Arteritis., 96-104. https://doi.org/10.1159/000092388 Seko, Y., Minota, S., Kawasaki, A., Shinkai, Y., Maeda, K., Yagita, H., … & Tada, Y. (1994). Perforin-secreting Killer Cell Infiltration and Expression Of A 65-kd Heat-shock Protein In Aortic Tissue Of Patients With Takayasu’s Arteritis.. J. Clin. Invest., 2(93), 750-758. https://doi.org/10.1172/jci117029 Shenoy, R., French, K., Eke, T., Mukhtyar, C. (2023). Recognizing Giant Cell Arteritis In Dental Practice. Dent Update, 3(50), 204-208. https://doi.org/10.12968/denu.2023.50.3.204 Sørensen, P., Lorenzen, I. (2009). Giant-cell Arteritis, Temporal Arteritis and Polymyalgia Rheumatica. Acta Medica Scandinavica, 1-6(201), 207-213. https://doi.org/10.1111/j.0954-6820.1977.tb15683.x Vrînceanu, D., Dumitru, M., Bănică, B., Eftime, I., Patrascu, O., Costache, A., … & Georgescu, M. (2021). Role Of Temporal Artery Resection In Horton’s Arteritis (Review). Exp Ther Med, 4(22). https://doi.org/10.3892/etm.2021.10533 Zakrzewska, J. (2013). Differential Diagnosis Of Facial Pain and Guidelines For Management. British Journal of Anaesthesia, 1(111), 95-104. https://doi.org/10.1093/bja/aet125

Bioactive Glass in Dentistry

Anisha ValliLeave a comment

Hey peeps! 🌟 Let’s talk about the coolest thing in dentistry right now – bioactive glass! 🦷💎 This stuff is like magic – it bonds to living tissues and helps regenerate bones and teeth! 😮💪 Made of fancy ingredients like silicon dioxide, calcium oxide, and fluoride, it’s like a superhero dental material! 🦸‍♂️✨ Bioactive glass toothpaste? Yep, it exists! It protects our pearly whites from dental bleaching damage! 🙅‍♀️😁 And get this – it’s used in dental restorations, root canals, and even implants! 😎🚀 Plus, it’s rocking the world of tissue engineering too! 🧪🧬 But hold up, we need more research to unlock its full potential and make sure it’s safe! 💡🔍 So, brace yourselves for the future of dentistry with bioactive glass! 💙🦷

Bioactive glass has gained significant attention in the field of dentistry due to its unique properties and potential applications. Bioactive glass refers to a group of materials that can bond to living tissues and promote the regeneration of hard tissues such as bone and teeth (Skallevold et al., 2019). It is composed of silicon dioxide, sodium dioxide, calcium oxide, and phosphorus pentoxide (Al-Harbi et al., 2021). The addition of fluoride to bioactive glasses has been of great interest in the development of dental biomaterials (Brauer et al., 2009). Fluoride-containing bioactive glasses combine the bone-bonding ability of bioactive glasses with the anticariogenic protection provided by fluoride ions (Pedone et al., 2012). These glasses have been used in various dental applications, including dental restorative materials, mineralizing agents, coating materials for dental implants, pulp capping, root canal treatment, and air abrasion procedures (Skallevold et al., 2019).

The use of bioactive glass in dentistry has been driven by the need for improved dental materials that are biocompatible, regenerative, and compatible with advanced technologies (Montazerian & Zanotto, 2016). Dental glass-ceramics, which are easy to process and have outstanding properties, have gained significant importance in the field (Montazerian & Zanotto, 2016). Bioactive glass-based toothpaste has been developed to protect enamel against the deleterious effects of dental bleaching (Vieira-Junior et al., 2016). Bioactive glass nanoparticles have also been used to modify glass ionomer cement, resulting in increased compressive, tensile, and flexural strengths (Leung et al., 2022). However, further studies are needed to determine the long-term effects of these nanoparticles on the human body before their widespread clinical application in dentistry (Leung et al., 2022).

Bioactive glass has shown promising results in the remineralization of demineralized enamel and dentin, making it a potential material for the management of dental caries (Mei & Chu, 2019). It has been incorporated into toothpastes as a mineralizing and desensitizing agent (Gjorgievska et al., 2013). The release of fluoride ions from acrylic resin modified with bioactive glass has also been studied, highlighting its potential for preventing tooth decay and promoting remineralization (Raszewski et al., 2021).

In addition to its applications in restorative dentistry, bioactive glass has been used in endodontics as a direct pulp capping agent and in periodontology for the regeneration of periodontal bone support (Hanada et al., 2018; Curtis et al., 2010). It has also been incorporated into scaffolds and coatings for tissue engineering purposes, including bone tissue engineering (Covarrubias et al., 2018; Erol-Taygun et al., 2013). The use of bioactive glass in dental implants has been explored, with bioactive glass coatings being applied to zirconia substrates to promote bone bonding and accelerate healing (Zhang & Le, 2020).

Overall, bioactive glass has shown great potential in various dental applications, including restorative materials, mineralizing agents, dental implants, pulp capping, and tissue engineering. Its unique properties, such as biocompatibility, bioactivity, and regenerative capabilities, make it a promising material for the advancement of dentistry. However, further research is needed to fully understand its long-term effects and optimize its properties for specific applications.

REFERENCES

Al-Harbi, N., Mohammed, H., Al-Hadeethi, Y., Bakry, A., Umar, A., Hussein, M., … & Nune, M. (2021). Silica-based Bioactive Glasses and Their Applications In Hard Tissue Regeneration: A Review. Pharmaceuticals, 2(14), 75. https://doi.org/10.3390/ph14020075 Alizadeh-Osgouei, M., Li, Y., Wen, C. (2019). A Comprehensive Review Of Biodegradable Synthetic Polymer-ceramic Composites and Their Manufacture For Biomedical Applications. Bioactive Materials, (4), 22-36. https://doi.org/10.1016/j.bioactmat.2018.11.003 Benetti, F., Queiroz, Í., Oliveira, P., Conti, L., Azuma, M., Oliveira, S., … & Cintra, L. (2019). Cytotoxicity and Biocompatibility Of A New Bioceramic Endodontic Sealer Containing Calcium Hydroxide. Braz. oral res., (33). https://doi.org/10.1590/1807-3107bor-2019.vol33.0042 Brauer, D., Karpukhina, N., Law, R., Hill, R. (2009). Structure Of Fluoride-containing Bioactive Glasses. J. Mater. Chem., 31(19), 5629. https://doi.org/10.1039/b900956f Cannio, M., Bellucci, D., Roether, J., Boccaccini, D., Cannillo, V. (2021). Bioactive Glass Applications: a Literature Review Of Human Clinical Trials. Materials, 18(14), 5440. https://doi.org/10.3390/ma14185440 Covarrubias, C., Cádiz, M., Maureira, M., Celhay, I., Cuadra, F., Marttens, A. (2018). Bionanocomposite Scaffolds Based On Chitosan–gelatin and Nanodimensional Bioactive Glass Particles: In Vitro Properties And In Vivo Bone Regeneration. J Biomater Appl, 9(32), 1155-1163. https://doi.org/10.1177/0885328218759042 Curtis, A., West, N., Su, B. (2010). Synthesis Of Nanobioglass and Formation Of Apatite Rods To Occlude Exposed Dentine Tubules And Eliminate Hypersensitivity. Acta Biomaterialia, 9(6), 3740-3746. https://doi.org/10.1016/j.actbio.2010.02.045 Erol-Taygun, M., Zheng, K., Boccaccini, A. (2013). Nanoscale Bioactive Glasses In Medical Applications. Int J Appl Glass Sci, 2(4), 136-148. https://doi.org/10.1111/ijag.12029 Gjorgievska, E., Nicholson, J., Slipper, I., Stevanovic, M. (2013). Remineralization Of Demineralized Enamel By Toothpastes: a Scanning Electron Microscopy, Energy Dispersive X-ray Analysis, And Three-dimensional Stereo-micrographic Study. Microsc Microanal, 3(19), 587-595. https://doi.org/10.1017/s1431927613000391 Guduric, V., Belton, N., Richter, R., Bernhardt, A., Spangenberg, J., Wu, C., … & Gelinsky, M. (2021). Tailorable Zinc-substituted Mesoporous Bioactive Glass/alginate-methylcellulose Composite Bioinks. Materials, 5(14), 1225. https://doi.org/10.3390/ma14051225 Hanada, K., Morotomi, T., Washio, A., Yada, N., Matsuo, K., Teshima, H., … & Kitamura, C. (2018). in Vitro and in Vivo Effects Of A Novel Bioactive Glass‐based Cement Used As A Direct Pulp Capping Agent. J. Biomed. Mater. Res., 1(107), 161-168. https://doi.org/10.1002/jbm.b.34107 Leung, G., Wong, A., Chu, C., Yu, O. (2022). Update On Dental Luting Materials. Dentistry Journal, 11(10), 208. https://doi.org/10.3390/dj10110208 Mei, M., Chu, C. (2019). Mechanisms Of Bioactive Glass On Caries Management: a Review. Materials, 24(12), 4183. https://doi.org/10.3390/ma12244183 Montazerian, M., Zanotto, E. (2016). Bioactive and Inert Dental Glass-ceramics. J. Biomed. Mater. Res., 2(105), 619-639. https://doi.org/10.1002/jbm.a.35923 Pedone, A., Charpentier, T., Menziani, M. (2012). The Structure Of Fluoride-containing Bioactive Glasses: New Insights From First-principles Calculations and Solid State Nmr Spectroscopy. J. Mater. Chem., 25(22), 12599. https://doi.org/10.1039/c2jm30890h Raszewski, Z., Nowakowska, D., Więckiewicz, W., Nowakowska-Toporowska, A. (2021). Release and Recharge Of Fluoride Ions From Acrylic Resin Modified With Bioactive Glass. Polymers, 7(13), 1054. https://doi.org/10.3390/polym13071054 Skallevold, H., Rokaya, D., Khurshid, Z., Zafar, M. (2019). Bioactive Glass Applications In Dentistry. IJMS, 23(20), 5960. https://doi.org/10.3390/ijms20235960 T, L. (2013). Bioglass: a Novel Biocompatible Innovation. J Adv Pharm Tech Res, 2(4), 78. https://doi.org/10.4103/2231-4040.111523 Vieira-Junior, W., Lima, D., Tabchoury, C., Ambrosano, G., Aguiar, F., Lovadino, J. (2016). Effect Of Toothpaste Application Prior To Dental Bleaching On Whitening Effectiveness and Enamel Properties. Operative Dentistry, 1(41), E29-E38. https://doi.org/10.2341/15-042-l Wang, Z. (2015). Bioceramic Materials In Endodontics. Endod Topics, 1(32), 3-30. https://doi.org/10.1111/etp.12075 Wang, Z., Jiang, T., Sauro, S., Wang, Y., Thompson, I., Watson, T., … & Haapasalo, M. (2011). Dentine Remineralization Induced By Two Bioactive Glasses Developed For Air Abrasion Purposes. Journal of Dentistry, 11(39), 746-756. https://doi.org/10.1016/j.jdent.2011.08.006 Wei, L., Li, Z., Li, J., Zhang, Y., Yao, B., Liu, Y., … & Huang, S. (2020). An Approach For Mechanical Property Optimization Of Cell-laden Alginate–gelatin Composite Bioink With Bioactive Glass Nanoparticles. J Mater Sci: Mater Med, 11(31). https://doi.org/10.1007/s10856-020-06440-3 Wu, C., Gaharwar, A., Schexnailder, P., Schmidt, G. (2010). Development Of Biomedical Polymer-silicate Nanocomposites: a Materials Science Perspective. Materials, 5(3), 2986-3005. https://doi.org/10.3390/ma3052986 Yudaev, P., Chuev, V., Klyukin, B., Rizos, A., Mezhuev, Y., Chistyakov, E. (2022). Polymeric Dental Nanomaterials: Antimicrobial Action. Polymers, 5(14), 864. https://doi.org/10.3390/polym14050864 Zhang, K., Le, Q. (2020). Bioactive Glass Coated Zirconia For Dental Implants: a Review. jcc, 1(2), 10-17. https://doi.org/10.29252/jcc.2.1.2

Diagnosis Demystified – Case 21

Anisha ValliLeave a comment

A 71-year-old woman attends your surgery complaining of a sharp pain which affects the back of her tongue and the area just beneath the angle of her jaw, always on the left-hand side alone. The pain lasts for about a minute and comes on when she swallows or chews. Her lower left first and second molar teeth are present and restored but they appear sound, are vital and are not tender to percussion.

While the tongue is commonly affected in burning mouth syndrome, the pain is of too short a duration and is described as sharp. The involvement of the area just below the angle of the jaw and pain on chewing might suggest dental pathology but the teeth are sound and not TTP. Similarly, were it not for the involvement of the tongue, a diagnosis of TN might be considered. However, taking into account the sites affected, the nature of the pain and when it is experienced, the diagnosis is glossopharyngeal neuralgia.

RESEARCH

Glossopharyngeal neuralgia is a rare condition that causes severe, stabbing pain in the throat, tongue, and ear. It happens because of a problem with a nerve called the glossopharyngeal nerve. This nerve is responsible for sending messages about feeling and pain from the throat and tongue to the brain. The exact cause of glossopharyngeal neuralgia is not fully understood, but it may be due to pressure on the nerve from blood vessels.

When someone has glossopharyngeal neuralgia, they experience sudden and intense pain attacks that can last for a short time. The pain can be triggered by things like swallowing, talking, or even just touching the affected area. It usually affects only one side of the face and can be very uncomfortable.

To diagnose glossopharyngeal neuralgia, doctors will ask about the person’s symptoms and do some tests. These tests may include imaging scans like an MRI to look for any problems with the nerve.

Treatment for glossopharyngeal neuralgia can involve medications to help manage the pain. Common medications include carbamazepine, oxcarbazepine, or gabapentin. In some cases, surgery may be necessary to relieve the pressure on the nerve. This can involve a procedure called microvascular decompression, where the blood vessels causing the compression are moved away from the nerve.

It’s important for dentists to be aware of glossopharyngeal neuralgia because it can cause neck pain that may be mistaken for dental problems. If a dentist suspects glossopharyngeal neuralgia, they will refer the patient to a specialist for further evaluation and treatment.

Overall, glossopharyngeal neuralgia is a rare condition that causes severe throat and ear pain. It can be diagnosed through medical tests and treated with medications or surgery. Dentists should be aware of this condition to provide appropriate referrals for their patients.

References:

Edvinsson, J., Viganò, A., Alekseeva, A., Alieva, E., Arruda, R., Luca, C., … & Haanes, K. (2020). The Fifth Cranial Nerve In Headaches. J Headache Pain, 1(21). https://doi.org/10.1186/s10194-020-01134-1 Fusco, D., Asteraki, S., Spetzler, R. (2012). Eagle’s Syndrome: Embryology, Anatomy, and Clinical Management. Acta Neurochir, 7(154), 1119-1126. https://doi.org/10.1007/s00701-012-1385-2 Gaul, C., Hastreiter, P., Duncker, A., Naraghi, R. (2011). Diagnosis and Neurosurgical Treatment Of Glossopharyngeal Neuralgia: Clinical Findings And 3-d Visualization Of Neurovascular Compression In 19 Consecutive Patients. J Headache Pain, 5(12), 527-534. https://doi.org/10.1007/s10194-011-0349-x Goel, V. (2020). Glossopharyngeal Neuralgia: An Approach To Diagnosis and Management. AHM Journal. https://doi.org/10.30756/ahmj.2020.02.07 Hamilton, K., Seligman, R., Blue, R., Lee, J. (2022). Refractory Glossopharyngeal Neuralgia Successfully Treated With Onabotulinumtoxina: a Case Report. Headache, 10(62), 1424-1428. https://doi.org/10.1111/head.14421 Han, A., Montgomery, C., Zamora, A., Winder, E., Carroll, C., Aquino, A., … & Kaye, A. (2022). Glossopharyngeal Neuralgia: Epidemiology, Risk Factors, Pathophysiology, Differential Diagnosis, and Treatment Options. Health Psychology Research, 5(10). https://doi.org/10.52965/001c.36042 Ishibashi, K., Yamanaka, K., Yamanaka, K. (2021). Gamma Knife Radiosurgery For Concurrent Trigeminal Neuralgia and Glossopharyngeal Neuralgia. Cureus. https://doi.org/10.7759/cureus.20717 Jiang, H., Zhou, D., Wang, P., Zeng, L., Liu, J., Tang, C., … & Wu, N. (2023). Case Report: Fully Endoscopic Microvascular Decompression For Glossopharyngeal Neuralgia. Front. Surg., (9). https://doi.org/10.3389/fsurg.2022.1089632 Khan, M., Nishi, S., Hassan, S., Islam, M., Gan, S. (2017). Trigeminal Neuralgia, Glossopharyngeal Neuralgia, and Myofascial Pain Dysfunction Syndrome: An Update. Pain Research and Management, (2017), 1-18. https://doi.org/10.1155/2017/7438326 Kim, J., Lee, C. (2021). Posterior Condylar Canal Dural Arteriovenous Fistula As a Rare Cause Of Glossopharyngeal Neuralgia: A Case Report. Headache, 8(61), 1281-1285. https://doi.org/10.1111/head.14190 Laha, R., Jannetta, P. (1977). Glossopharyngeal Neuralgia. Journal of Neurosurgery, 3(47), 316-320. https://doi.org/10.3171/jns.1977.47.3.0316 Liu, Q., Zhong, Q., Hong, Y., He, G. (2019). ≪p>ultrasound-guided Glossopharyngeal Nerve Block Via the Styloid Process For Glossopharyngeal Neuralgia: A Retrospective Study</p>. JPR, (Volume 12), 2503-2510. https://doi.org/10.2147/jpr.s214596 Mahalingappa, A., Gupta, R., Ramakrishnan, S. (2020). Glossopharyngeal Neuralgia Due To Exposed Glossopharyngeal Nerve Post Tonsillectomy and Transoral Styloidectomy. Int J Otorhinolaryngol Head Neck Surg, 9(6), 1725. https://doi.org/10.18203/issn.2454-5929.ijohns20203582 Martinez-Alvarez, R., Martinez-Moreno, N., Kusak, M., Rey-Portolés, G. (2014). Glossopharyngeal Neuralgia and Radiosurgery. JNS, Suppl_2(121), 222-225. https://doi.org/10.3171/2014.8.gks141273 Matak, I., Lacković, Z. (2014). Botulinum Toxin A, Brain and Pain. Progress in Neurobiology, (119-120), 39-59. https://doi.org/10.1016/j.pneurobio.2014.06.001 Memon, A., Samad, A., Finan, K. (2018). A Middle Age Woman With the Episodes Of Excruciating Pain In The Neck And Ear. Arch Clin Med Case Rep, 03(02), 65-67. https://doi.org/10.26502/acmcr.96550026 Nagata, K., Tajiri, K., Ueda, A., Okuda, Y., Tokimitsu, Y., Shinagawa, K., … & Yasuda, I. (2019). Glossopharyngeal Neuralgia With Syncope Caused By Recurrence Of Esophageal Squamous Cell Carcinoma. Intern. Med., 7(58), 933-936. https://doi.org/10.2169/internalmedicine.1838-18 Nishimura, S., Kubota, K., Okuyama, S., Matsuyama, J., Kazama, K., Tomii, M., … & Watanabe, K. (2021). Microvascular Decompression For Glossopharyngeal Neuralgia In the Semi-sitting Position: A Report Of Two Cases. Tohoku J. Exp. Med., 3(254), 183-188. https://doi.org/10.1620/tjem.254.183 O’Neill, F., Nurmikko, T., Sommer, C. (2017). Other Facial Neuralgias. Cephalalgia, 7(37), 658-669. https://doi.org/10.1177/0333102417689995 Pommier, B., Touzet, G., Lucas, C., Vermandel, M., Blond, S., Reyns, N. (2018). Glossopharyngeal Neuralgia Treated By Gamma Knife Radiosurgery: Safety and Efficacy Through Long-term Follow-up. Journal of Neurosurgery, 5(128), 1372-1379. https://doi.org/10.3171/2017.3.jns162542 Rahman, S., Singh, J., Muthusamy, R., Alam, M. (2018). The Development Of Eagle’s Syndrome After Neck Trauma. Contemp Clin Dent, 2(9), 319. https://doi.org/10.4103/ccd.ccd_870_17 Romero-Reyes, M., Salvemini, D. (2016). Cancer and Orofacial Pain. Med Oral, 0-0. https://doi.org/10.4317/medoral.21515 Souza, V., Passerini, M., Sobral, B., Baiardi, V. (2021). Clinical and Physiopathological Aspects Of The Glossopharyngeal Neuralgia. HM, 1(12), 5-11. https://doi.org/10.48208/headachemed.2021.2 Swain, B., Vidhya, S., Kumar, S. (2020). Eagle’s Syndrome Managed Successfully By Pulsed Radiofrequency Treatment. Cureus. https://doi.org/10.7759/cureus.10574 İlgüy, M., İlgüy, D., Güler, N., Bayirli, G. (2005). Incidence Of the Type And Calcification Patterns In Patients With Elongated Styloid Process. J Int Med Res, 1(33), 96-102. https://doi.org/10.1177/147323000503300110

Cantilever abutments (2m)

Anisha ValliLeave a comment
  1. A cantilever abutment is a type of dental prosthesis where an artificial tooth is supported by only one natural tooth
  2. The forces applied such as vertical, torsional, and bending forces to the prosthesis can cause the screw holding it in place to become loose or break, and the abutment tooth may also fracture
  3. Using a cantilever bridge with a resin coating has been found to be a reliable way to replace missing teeth in the lower jaw.
  4. The use of a support system with a short implant and ball-type abutment can reduce stress distribution and displacement in the cantilever extension of dental prostheses.

Lesion Sterilization Tissue Repair

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Lesion Sterilization Tissue Repair (LSTR) is a therapeutic approach used in dentistry for the treatment of oral infectious lesions, including dentinal, pulpal, and periradicular lesions (Vijayaraghavan et al., 2012). It involves the use of a combination of antibacterial drugs to disinfect the affected pulp and periapical tissues (Tedesco et al., 2021). The concept of LSTR was developed by the Cariology Research Unit of Niigata University School of Dentistry in Japan (Sain et al., 2018).

The antibacterial drugs used in LSTR therapy may vary, but commonly used combinations include metronidazole, ciprofloxacin, and minocycline (Vijayaraghavan et al., 2012). These drugs have been shown to have bactericidal activity against selected microorganisms (Nalawade et al., 2015). The mixture of three antibacterial drugs, known as 3Mix, has been found to effectively sterilize carious lesions, necrotic pulps, and infected root dentine of primary teeth (Nakornchai et al., 2010). The use of 3Mix in LSTR therapy has been shown to promote tissue repair and regeneration (Nanda et al., 2014).

LSTR therapy is considered a non-instrumentation endodontic treatment, as it does not involve mechanical instrumentation of the root canal system (Duanduan et al., 2013). This approach helps prevent over-enlargement of the root canal and unnecessary irritation of periapical tissue (Duanduan et al., 2013). Instead, LSTR therapy focuses on disinfecting the affected pulp and periapical tissues with an antibacterial paste (Tedesco et al., 2021). The antibacterial paste is typically applied to the lesion and left in place for a certain period to allow for disinfection and tissue repair (Doneria et al., 2017).

The success of LSTR therapy has been demonstrated in various studies. It has been shown to be effective in the treatment of infected primary molars (Nakornchai et al., 2010), pulpotomies of infected primary molars (Daher et al., 2015), and non-vital pulp treatment in primary teeth (Duanduan et al., 2013). LSTR therapy has been found to increase the longevity of deciduous teeth in young children (Sain et al., 2018). It has also been shown to be a suitable alternative to conventional pulpectomy in primary molars (Agarwal et al., 2011).

In addition to its effectiveness, LSTR therapy offers several advantages. It preserves tooth structure by avoiding excessive instrumentation of root canals (Singhal et al., 2021). It also promotes tissue repair and regeneration through the host’s natural tissue responses (Sain et al., 2018). LSTR therapy has been found to have a high success rate and can be considered a reliable treatment option (Malu & Khubchandani, 2022).

However, it is important to note that LSTR therapy may be associated with some limitations. Discoloration of the treated tooth has been reported as a potential side effect of LSTR therapy (Prasad et al., 2017). Antibiotic resistance can also decrease the efficacy of endodontic filling pastes used in LSTR therapy (Rivera-Albarrán et al., 2021). Further research is needed to explore the clinical applications and long-term outcomes of LSTR therapy (Garrocho-Rangel et al., 2021).

In conclusion, Lesion Sterilization Tissue Repair (LSTR) is a therapeutic approach used in dentistry for the treatment of oral infectious lesions. It involves the use of a combination of antibacterial drugs to disinfect the affected pulp and periapical tissues. LSTR therapy has been shown to be effective in various dental conditions, including infected primary molars and non-vital pulp treatment in primary teeth. It offers advantages such as preserving tooth structure and promoting tissue repair and regeneration. However, it may be associated with limitations such as tooth discoloration and antibiotic resistance. Further research is needed to explore the clinical applications and long-term outcomes of LSTR therapy.

References:

Agarwal, A., Das, U., Vishwanath, D., Praveen, B. (2011). A Comparative Evaluation Of Noninstrumentation Endodontic Techniques With Conventional Zoe Pulpectomy In Deciduous Molars: An In Vivo Study. World Journal of Dentistry, 3(2), 187-192. https://doi.org/10.5005/jp-journals-10015-1081 Betal, S. (2022). Antibiotic Usage In Pediatric Dentistry: a Review. JDP, 2(4), 64-69. https://doi.org/10.18231/j.jdp.2022.013 Castro, M., Lima, M., Lima, C., Moura, M., Moura, L., Moura, L. (2023). Lesion Sterilization and Tissue Repair With Chloramphenicol, Tetracyline, Zinc Oxide/eugenol Paste Versus Conventional Pulpectomy: A 36‐month Randomized Controlled Trial. Int J Paed Dentistry. https://doi.org/10.1111/ipd.13056 Daher, A., Viana, K., Leles, C., Costa, L. (2015). Ineffectiveness Of Antibiotic-based Pulpotomy For Primary Molars: a Survival Analysis. Pesqui. bras. odontopediatria clín. integr., 1(15), 205-215. https://doi.org/10.4034/pboci.2015.151.22 Desai, A., Jathar, P., Kulkarni, S., Panse, A., Salunkhe, B., Jathar, M. (2022). Treatment Of Pulpally Involved Primary Molars Utilizing Lstr: Report Of Two Cases. Int. J. Appl. Dent. Sci., 3(8), 118-123. https://doi.org/10.22271/oral.2022.v8.i3b.1595 Dias, G., Tramontin, J., Santos, P., Rossi, F., Rigoni, M. (2021). Evaluation Of Pulping Therapy In Deciduous Teeth Using Chlorhephenicol Tetracycline and Zinc Oxide. RGO, Rev. Gaúch. Odontol., (69). https://doi.org/10.1590/1981-863720210004920200008 Doneria, D., Thakur, S., Singhal, P., Chauhan, D., Keshav, K., Uppal, A. (2017). In Search Of a Novel Substitute: Clinical And Radiological Success Of Lesion Sterilization And Tissue Repair With Modified 3mix-mp Antibiotic Paste And Conventional Pulpectomy For Primary Molars With Pulp Involvement With 18 Months Follow-up. Contemp Clin Dent, 4(8), 514. https://doi.org/10.4103/ccd.ccd_47_17 Duanduan, A., Sirimaharaj, V., Chompu-inwai, P. (2013). Retrospective Study Of Pulpectomy With Vitapex® and Lstr With Three Antibiotics Combination (3mix) For Non-vital Pulp Treatment In Primary Teeth. CMUJNS, 2(12). https://doi.org/10.12982/cmujns.2013.0012 Garrocho-Rangel, A., Jalomo-Ávila, C., Rosales-Berber, M., Pozos-Guillén, A. (2021). Lesion Sterilization Tissue Repair (Lstr) Approach Of Non-vital Primary Molars With a Chloramphenicol-tetracycline-zoe Antibiotic Paste: A Scoping Review. Journal of Clinical Pediatric Dentistry, 6(45), 369-375. https://doi.org/10.17796/1053-4625-45.6.1 Hossain, I., Choudhury, N., Alam, S., Beauty, S., Uddin, F. (2020). Evaluation Of Lstr 3 MIX Mp Therapy For Healing Of Periapical Pathosis Of Nonvital Teeth. TAJ: J of Teachers Assoc, 2(33), 76-84. https://doi.org/10.3329/taj.v33i2.51343 Hossain, I., Parveen, M., Choudhury, N., Wakia, T., Uddin, F., Rahman, S. (2020). Evaluation Of Conventional Root Canal Treatment For Healing Of Periapical Pathosis Of Nonvital Teeth. TAJ: J of Teachers Assoc, 1(33), 25-30. https://doi.org/10.3329/taj.v33i1.49821 Kharadly, D., Tawil, S., Nasr, R., Beshlawy, D. (2022). Triple Antibiotic Paste and Simvastatin In The Treatment Of Non-vital Primary Molars With Inflammatory Root Resorption. ijhs, 3715-3728. https://doi.org/10.53730/ijhs.v6ns6.10439 Malu, K., Khubchandani, M. (2022). Triple Antibiotic Paste: a Suitable Medicament For Intracanal Disinfection. Cureus. https://doi.org/10.7759/cureus.29186 Nakornchai, S., Banditsing, P., Visetratana, N. (2010). Clinical Evaluation Of 3mix and Vitapex®as Treatment Options For Pulpally Involved Primary Molars. International Journal of Paediatric Dentistry, 3(20), 214-221. https://doi.org/10.1111/j.1365-263x.2010.01044.x Nalawade, T., Bhat, K., Sogi, S. (2015). Bactericidal Activity Of Propylene Glycol, Glycerine, Polyethylene Glycol 400, and Polyethylene Glycol 1000 Against Selected Microorganisms. J Int Soc Prevent Communit Dent, 2(5), 114. https://doi.org/10.4103/2231-0762.155736 Nanda, R., Koul, M., Srivastava, S., Upadhyay, V., Dwivedi, R. (2014). Clinical Evaluation Of 3 MIX and Other Mix In Non-instrumental Endodontic Treatment Of Necrosed Primary Teeth. Journal of Oral Biology and Craniofacial Research, 2(4), 114-119. https://doi.org/10.1016/j.jobcr.2014.08.003 Parakh, K., Kothari, S., Daga, P., Harsha, G., Sarda, R., Tamrakar, A. (2021). Lesion Sterilization and Tissue Repair Therapy Using Gam Antibiotic Paste. ijhs, 453-458. https://doi.org/10.53730/ijhs.v5ns2.6189 Prasad, M., Ramakrishna, J., Babu, D. (2017). Allogeneic Stem Cells Derived From Human Exfoliated Deciduous Teeth (Shed) For the Management Of Periapical Lesions In Permanent Teeth: Two Case Reports Of A Novel Biologic Alternative Treatment. J Dent Res Dent Clin Dent Prospects, 2(11), 117-122. https://doi.org/10.15171/joddd.2017.021 Rai, R., Shashibhushan, K., Babaji, P., Chandrappa, P., Reddy, V., Ambareen, Z. (2019). Clinical and Radiographic Evaluation Of 3mix And Vitapex As Pulpectomy Medicament In Primary Molars: An In Vivo Study. International Journal of Clinical Pediatric Dentistry, 6(12), 532-537. https://doi.org/10.5005/jp-journals-10005-1686 Rivera-Albarrán, C., Morales-Dorantes, V., Ayala-Herrera, J., Castillo-Aguillón, M., Soto-Barreras, U., Cabeza-Cabrera, C., … & Domínguez-Pérez, R. (2021). Antibiotic Resistance Decreases the Efficacy Of Endodontic Filling Pastes For Root Canal Treatment In Children′s Teeth. Children, 8(8), 692. https://doi.org/10.3390/children8080692 Sain, S., Reshmi, J., Anandaraj, S., George, S., Issac, J., John, S. (2018). Lesion Sterilization and Tissue Repair–current Concepts And Practices. 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Triple Antibiotic Paste In Root Canal Therapy. J Pharm Bioall Sci, 6(4), 230. https://doi.org/10.4103/0975-7406.100214

Diagnosis Demystified – Case 20

Anisha ValliLeave a comment

A 65-year-old woman complained of a deep-seated aching sensation affecting the right-hand side of her face from her top jaw up to her forehead. She has suffered from the pain more or less continuously for about 4 years. There are no exacerbating or ameliorating factors. Analgesics have proved ineffective. Her GP referred her to an ENT consultant who carried out an MRI to check for sinus problems. She has also been seen by two other dentists and had root canal treatment on several teeth, two of which have subsequently been extracted. On examination, you detect no abnormalities.

So, what’s the dealio? Drumroll, please… It’s atypical facial pain! 💥🎉 The pain is constant, doesn’t get worse or better, and there are no triggers. Classic atypical vibes! 💯 We throw in an MRI just to make sure, but honestly, it’s mostly for reassurance. 🙌

Basically, it’s chronic face pain without any obvious causes. 🙅‍♀️ The diagnosis is like playing detective – ruling out other possible causes first! 🔍 This condition can be tricky since exams and tests often come back normal. 🤔 So, what’s the deal with treatment? It’s not a walk in the park! 😬 Docs try different approaches like meds, nerve blocks, physical therapy, even alternative therapies! 🌿💊 But here’s the kicker – evidence for their effectiveness is limited, and more research is needed!

RESEARCH

Atypical facial pain is a condition characterized by chronic facial pain without any identifiable structural or specific causes (Maarbjerg et al., 2016). It is often diagnosed based on the patient’s history, absence of neurological and radiological signs, and negative imaging results (Derbyshire et al., 1994). The pain is typically described as dull, aching, or nagging, and it may be continuous or intermittent (Deun et al., 2020). Atypical facial pain is considered a diagnosis of exclusion, meaning that other potential causes of facial pain must be ruled out before making this diagnosis (Deun et al., 2020).

Patients with atypical facial pain often present with normal neurological, radiological, and dental examination findings (Derbyshire et al., 1994). This can make the diagnosis challenging, as there are no specific tests or imaging studies that can definitively confirm the presence of atypical facial pain (Benoliel & Gaul, 2017). However, it is important to conduct a thorough evaluation to rule out other possible causes of facial pain, such as dental issues, temporomandibular disorders, sinusitis, and neuropathic conditions (Goel et al., 2015).

The exact etiology of atypical facial pain is not well understood. Traumatic neuropathic mechanisms are suspected to play a role in the development of the condition (Benoliel & Gaul, 2017). It has been suggested that the pain may be related to dysfunctional pain processing in the central nervous system (Weiss et al., 2017). Psychological factors, such as stress and anxiety, may also contribute to the development and maintenance of atypical facial pain (Mykletun et al., 2006).

Treatment for atypical facial pain is often challenging and may require a multidisciplinary approach. The goal of treatment is to alleviate pain and improve the patient’s quality of life. Various treatment modalities have been used, including medications, nerve blocks, physical therapy, cognitive-behavioral therapy, and alternative therapies such as acupuncture (Weiss et al., 2017; Naik et al., 2014). However, the evidence for the effectiveness of these treatments is limited, and more research is needed to determine the optimal approach for managing atypical facial pain (Weiss et al., 2017).

In conclusion, atypical facial pain is a chronic condition characterized by facial pain without any identifiable structural or specific causes. It is diagnosed based on the patient’s history, absence of neurological and radiological signs, and negative imaging results. The exact etiology of atypical facial pain is not well understood, but traumatic neuropathic mechanisms and dysfunctional pain processing in the central nervous system are suspected to play a role. Treatment for atypical facial pain is challenging and often requires a multidisciplinary approach. Further research is needed to improve our understanding of the condition and develop more effective treatment strategies.

References:

Akbaş, M., Salem, H., Emara, T., Dinc, B., Karsli, B. (2019). Radiofrequency Thermocoagulation In Cases Of Atypical Trigeminal Neuralgia: a Retrospective Study. Egypt J Neurol Psychiatry Neurosurg, 1(55). https://doi.org/10.1186/s41983-019-0092-9 Benoliel, R., Gaul, C. (2017). Persistent Idiopathic Facial Pain. Cephalalgia, 7(37), 680-691. https://doi.org/10.1177/0333102417706349 Delcanho, R., Peck, C. (2018). Neuropathic Pain: Diagnosis and Treatment From The Dental Clinic To The Multidisciplinary Pain Clinic. Aust Endod J, 2(44), 114-124. https://doi.org/10.1111/aej.12276 Derbyshire, S., Jones, A., Devani, P., Friston, K., Feinmann, C., Harris, M., … & Frackowiak, R. (1994). Cerebral Responses To Pain In Patients With Atypical Facial Pain Measured By Positron Emission Tomography.. Journal of Neurology, Neurosurgery & Psychiatry, 10(57), 1166-1172. https://doi.org/10.1136/jnnp.57.10.1166 Deun, L., Witte, M., Goessens, T., Halewyck, S., Ketelaer, M., Matic, M., … & Versijpt, J. (2020). Facial Pain: a Comprehensive Review And Proposal For A Pragmatic Diagnostic Approach. Eur Neurol, 1(83), 5-16. https://doi.org/10.1159/000505727 Foerster, Z., Kleinmann, B., Schlueter, N., Vach, K., Wolter, T. (2022). Multimodal Pain Therapy For Persistent Idiopathic Facial Pain – a Pilot Study. BioPsychoSocial Med, 1(16). https://doi.org/10.1186/s13030-022-00254-1 Forssell, H., Alstergren, P., Bakke, M., Bjørnland, T., Jääskeläinen, S. (2016). Persistent Facial Pain Conditions. Tidende, 1(126). https://doi.org/10.56373/2016-1-7 Garcia, R., Chen, Q., Posadas, E., Tran, J., Kwon, A., Qian, X. (2023). Continuous Ketamine Infusion As a Treatment For Refractory Facial Pain. Cureus. https://doi.org/10.7759/cureus.35638 Goel, R., Kumar, S., Panwar, A., Singh, A. (2015). Pontine Infarct Presenting With Atypical Dental Pain: a Case Report. TODENTJ, 1(9), 337-339. https://doi.org/10.2174/1874210601509010337 Kalyani, P., Chaudhary, M., Kumar, M. (2020). Prevalence Of Orofacial Pain Among Working Adults – a Retrospective Study. ijrps, SPL4(11), 496-502. https://doi.org/10.26452/ijrps.v11ispl4.3889 Lucas, J., Nida, A., Isom, S., Marshall, K., Bourland, J., Laxton, A., … & Chan, M. (2014). Predictive Nomogram For the Durability Of Pain Relief From Gamma Knife Radiation Surgery In The Treatment Of Trigeminal Neuralgia. International Journal of Radiation Oncology*Biology*Physics, 1(89), 120-126. https://doi.org/10.1016/j.ijrobp.2014.01.023 Maarbjerg, S., Wolfram, F., Heinskou, T., Rochat, P., Gozalov, A., Brennum, J., … & Bendtsen, L. (2016). Persistent Idiopathic Facial Pain – a Prospective Systematic Study Of Clinical Characteristics And Neuroanatomical Findings At 3.0 Tesla Mri. Cephalalgia, 13(37), 1231-1240. https://doi.org/10.1177/0333102416675618 McCartney, S., Weltin, M., Burchiel, K. (2013). Use Of An Artificial Neural Network For Diagnosis Of Facial Pain Syndromes: An Update. 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Neuropathic Pain After Dental Treatment. Agri, 1(25), 1-6. https://doi.org/10.5505/agri.2013.55477 Vadhanan, P. (2022). Persistent Idiopathic Facial Pain Treated With Botulinum Toxin and Pulsed Radiofrequency Of Infraorbital Nerve: A Case Report. J Dent Anesth Pain Med, 1(22), 67. https://doi.org/10.17245/jdapm.2022.22.1.67 Weiss, A., Ehrhardt, K., Tolba, R. (2017). Atypical Facial Pain: a Comprehensive, Evidence-based Review. Curr Pain Headache Rep, 2(21). https://doi.org/10.1007/s11916-017-0609-9 Zakrzewska, J. (2016). Chronic/persistent Idiopathic Facial Pain. Neurosurgery Clinics of North America, 3(27), 345-351. https://doi.org/10.1016/j.nec.2016.02.012