Atypical odontalgia and trigeminal neuralgia: psychological, behavioural and psychopharmacologic approach – an overview of the pathologies related to the challenging differential diagnosis in orofacial pain

Orofacial pain represents a challenge for dentists, especially if with a non-odontogenic basis. Orofacial neuropathic pain is chronic, arduous to localize and develops without obvious pathology. Comorbid psychiatric disorders, such as anxiety and depression, coexist and negatively affect the condition. This article presents one case of atypical odontalgia and one of trigeminal neuralgia treated with psychological and psychopharmacologic tailored and adapted therapies, after conventional medications had failed. In addition, an overview of the pathologies related to the challenging differential diagnosis in orofacial pain is given, since current data are insufficient. A 68-year-old male complained of chronic throbbing, burning pain in a maxillary tooth, worsening upon digital pressure. Symptoms did not abate after conventional amitriptyline therapy; psychological intervention and antianxiety drug were supplemented and antidepressant agent dosage incremented; the patient revealed improvement and satisfaction with the multidisciplinary approach to his pathology. A 72-year-old male lamented chronic stabbing, intermittent, sharp, shooting and electric shock-like pain in an upper tooth, radiating and following the distribution of the trigeminal nerve. Pain did not recur after psychological intervention and a prescription of antidepressant and antianxiety agents, while conventional carbamazepine therapy had not been sufficient to control pain. Due to concern with comorbid psychiatric disorders, we adopted a patient-centered, tailored and balanced therapy, favourably changing the clinical outcome. Comorbid psychiatric disorders have a negative impact on orofacial pain and dentists should consider adopting tailored therapies, such as psychological counselling and behavioural and psychopharmacologic strategies, besides conventional treatments. They also need to be familiar with the signs and symptoms of orofacial pain, recollecting a comprehensive view of the pathologies concerning the differential diagnosis. A prompt diagnosis prevents pain chronicity, avoiding an increase in complexity and a shift to orofacial neuropathic pain and legal claims

A case series analysing patients with dental anxiety: a patient-centred model based on psychological profiling

Anxiety and distress can jeopardize dental care experience of patients and may affect the clinical result. Although a wide range of sedation and analgesia techniques are currently available to relieve distress and pain during dental procedures, operative models to choose the most effective sedation-analgesic strategies are lacking. This case series proposes a patient-centred model to optimize patients' cooperation during dental care delivery. We describe how to achieve correct anaesthesia by using the least sedative procedure, accounting for the dental procedure needed and patient's psychological profile. Five patients were considered as paradigmatic to show the balance between patients' subjective experiences and the clinical procedures: a patient with low stress, good compliance (case 1); moderate stress and reduction in compliance (case 2); anxious patient (case 3); patient with acute anxiety and emotional distress (case 4); anguished patient (case 5). A multimodal treatment of emotional and behavioural condition and a patient-centred model approach contributed to achieve the best patient satisfaction in the five cases detailed here

The River Contract of the Tiber from Castel Giubileo to the Foce: An Innovative Practice for a Relationship between Tiber and Rome

The River Contract is a little-known practice and an unconventional planning procedure but an opportunity in many Italian Regions to overcome the problems of coherence between levels of Government and to promote participation. The River Contract is a voluntary agreement of strategic and negotiated planning, aiming the protection, proper management of water resources, recovery, and enhancement of the river territories, together with flood protection, contributing to the local development of such areas. In 2017, in Rome, started the procedure for the River Contract by Agenda Tevere Onlus. This paper illustrates a practice-oriented research built by multidisciplinary approach and a method able to mix cultural and participatory knowledge. Because the Tiber is the river of Rome, the research aims to raise the possibility of enhancing the strategic and fundamental role of the Tiber in relation to the City through four key issues: the urban landscape, because the Tiber is intrinsically related with the city; the public space, because the Tiber must be a good of the city; the sustainable use, because the Tiber must be for the city; the active participation, because the interventions on the Tiber must be shared in the city by those who live and work in Rome

Incidence and Risk of Cytomegalovirus Infection during Pregnancy in an Urban Area of Northern Italy

The fetal consequences of CMV infection make it one of the most serious infections contracted during pregnancy, but the scientific community is divided over the proposed implementation of preventive screening for anti-CMV antibodies. The aim of this study was to assess the incidence and risk of infection during pregnancy in 2817 women who underwent anti-CMV IgG and IgM antibody screening during the period 2005–2007. The prevalence of anti-CMV IgG antibodies was 68.3% (95% CI: 66.6–70.0); the seroconversion rate in the 892 seronegative women was 0.32%; the results of IgG avidity testing revealed an cumulative incidence of 1.4% (95% CI: 0.97–1.83), density incidence of 0.8% (as cases/pregnant woman-trimester) (95% CI: 0.47–1.13), and a risk of infection of 0.5% (95% CI: 0.24–0.76). The screening identified 13 cases of primary infection (84.6% of which occurred in the first trimester of pregnancy). The possibility to identify these cases and consequently to plan appropriate interventions, supports the use of screening during pregnancy, especially in the first trimester when the risk of infection is greater

Terahertz dipole nanoantenna arrays: resonance characteristics

Resonant dipole nanoantennas promise to considerably improve the capabilities of terahertz spectroscopy, offering the possibility of increasing its sensitivity through local field enhancement, while in principle allowing unprecedented spatial resolutions, well below the diffraction limit. Here, we investigate the resonance properties of ordered arrays of terahertz dipole nanoantennas, both experimentally and through numerical simulations. We demonstrate the tunability of this type of structures, in a range (∼1–2 THz) that is particularly interesting and accessible by means of standard zinc telluride sources. We additionally study the near-field resonance properties of the arrays, finding that the resonance shift observed between near-field and far-field spectra is predominantly ascribable to ohmic damping

La suggestione e il suo ruolo nella clinica tra passato, presente e futuro

Neuroscience has offered confirmation that perception of reality does not correspond to reality. The mind is a very effective tool of falsification, because it builds "virtual scenarios" so persuasive that they are interpreted by human beings for "reality". It has been known since ancient times that words have power over reality and philosophical disciplines have often dealt with the relationship between language and reality. Suggestion is based on a particular form of communication, traditionally used in care, that includes a set of techniques for manipulating expectations and perceptions. In many human activities the suggestion reached a high level of complexity and has been widely applied; main areas are advertising, economic choice and political vote. For over a century, however, medicine, in search of scientific foundations, has neglected the role of suggestion in the clinical field. The authors illustrate some historical paths of suggestion in medical context and an overview of its presence, sometimes not recognized and not studied, in various areas of the current clinic practice.Da tempo si è iniziato a dubitare che il rapporto con la realtà sia oggettivo e unicamente centrato su aspetti logico-razionali. Le neuroscienze hanno offerto conferme al fatto che la percezione della realtà non corrisponda alla realtà. La mente è uno strumento di falsificazione molto efficace, perché costruisce “scenari virtuali” così persuasivi da essere scambiati dagli esseri umani per “realtà”. È noto fin dall’antichità che le parole hanno potere sulla realtà e le discipline filosofiche si sono occupate spesso del rapporto tra linguaggio e realtà. La suggestione può essere intesa come una particolare forma di comunicazione, tradizionalmente impiegata nella cura, che comprende un insieme di tecniche per manipolare aspettative e percezioni. In molte attività umane il tema della suggestione ha raggiunto un alto livello di elaborazione ed è stato diffusamente applicato; tra questi ambiti ricordiamo quello pubblicitario, della scelta economica e del voto politico. Da oltre un secolo la medicina, alla ricerca di fondamenti scientifici, ha però trascurato il ruolo della suggestione nei processi di cura. Gli autori illustrano alcuni percorsi storici della suggestione nella cura e una panoramica della sua presenza, talvolta non riconosciuta e non studiata, in vari ambiti della clinica attuale

Extremely large extinction efficiency and field enhancement in terahertz resonant dipole nanoantennas

The distinctive ability of nanometallic structures to manipulate light at the nanoscale has recently promoted their use for a spectacular set of applications in a wide range of areas of research including artificial optical materials, nano-imaging, biosensing, and nonlinear optics. Here we transfer this concept to the terahertz spectral region, demonstrating a metal nanostructure in shape of a dipole nanoantenna, which can efficiently resonate at terahertz frequencies, showing an effective cross section >100 times larger than its geometrical area, and a field enhancement factor of ~280, confined on a lateral section of ~λ/1,000. These results lead to immediate applications in terahertz artificial materials exhibiting giant dichroism, suggest the use of dipole nanoantennas in nanostructure-based terahertz metamaterials, and pave the way for nanoantenna-enhanced terahertz few-molecule spectroscopy and localized terahertz nonlinear optics

Search for Anti-EA(D) Antibodies in Subjects with an “Isolated VCA IgG” Pattern

The presence of an “isolated viral capsid antigen (VCA) IgG” pattern in serum is not easy to interpret without the aid of further tests, such as specific immunoblotting or a virus genome search, that often give rise to organisational and economic problems. However, one alternative is to use an enzyme-linked immunosorbent assay (ELISA) to detect anti-early antigen (EA) antibodies, which can be found in about 85% of subjects with acute Epstein-Barr virus (EBV) infections. The purpose of this work was to search for anti-EA(D) antibodies in 130 samples with an isolated VCA IgG pattern at ELISA screening and classified as being indicative of past (102 cases) or acute (28 cases) infection on the basis of the immunoblotting results. Thirty-seven samples (28.5%) were positive for anti-EA(D), of which 25 (89.3%) had been classified by immunoblotting as indicating acute and 12 (11.8%) past EBV infection. This difference was statistically significant (P < .01). The results of our search for anti-EA(D) antibodies correctly identified nearly 90% of acute (presence) or past EBV infections (absence). When other tests are not available, the search for anti-EA antibodies may therefore be helpful in diagnosing patients with an isolated VCA IgG pattern at screening tests