Potential differences in somatosensory function during premenopause and early and late postmenopause in patients with burning mouth syndrome: An observational case–control study

Background/purpose: Burning mouth syndrome (BMS) is a chronic condition presenting as intraoral burning or dysesthesia, with a high preponderance in menopausal women. This study aimed to examine the association between somatosensory dysfunction and BMS in premenopausal, early postmenopausal, and late postmenopausal patients, using a standardized Quantitative Sensory Testing (QST) protocol, and to determine the predictive value of thermal or mechanical perception by QST for detecting BMS. Materials and methods: An observational case–control study was performed with 36 female participants with BMS (12 premenopausal, 10 early postmenopausal, and 14 late postmenopausal) and 42 age- and sex-matched healthy volunteers (21 premenopausal, 10 early postmenopausal, and 11 late postmenopausal). Neurophysiological tests were used to evaluate somatosensory dysfunction at the tongue. Results: Z-score in the late postmenopausal BMS group revealed a gain of function for the cold pain threshold and heat pain threshold (Z = 2.08 and 3.38, respectively). In the multiple regression analysis with the Visual Analog Scale as the dependent variable, the vibration detection threshold predicted the severity of burning mouth sensation in the premenopausal group. Conclusion: Late postmenopausal patients with BMS showed an increased response of the tongue to noxious thermal stimuli. This supports the theory that changes in sex hormones may affect trigeminal somatosensory function, particularly during the late postmenopausal stage in patients with BMS

Oynophagia in patients after dental extraction: surface electromyography study

OBJECTIVES: Surface electromyographic (sEMG) studies were performed on 40 adult patients following extraction of lower third and second molars to research the approach and limitations of sEMG evaluation of their odynophagia complaints. METHODS: Parameters evaluated during swallowing and drinking include the timing, number of swallows per 100 cc of water, and range (amplitude) of EMG activity of m. masseter, infrahyoid and submental-submandibular group. The above mentioned variables (mean + standard deviation) were measured for the group of dental patients (n = 40) and control group of healthy adults (n = 40). RESULTS: The duration of swallows and drinking in all tests showed increase in dental patients' group, in which this tendency is statistically significant. There was no statistically significant difference between male and female adults' duration and amplitude of muscle activity during continuous drinking in both groups (p = 0.05). The mean of electric activity (in μV) of m. masseter was significantly lower in the dental patients' group in comparison with control group. The electric activity of submental-submandimular and infrahyoid muscle groups was the same in both groups. CONCLUSION: Surface EMG of swallowing is a simple and reliable noninvasive method for evaluation of odynophagia/dysphagia complaints following dental extraction with low level of discomfort of the examination. The surface EMG studies prove that dysphagia following dental extraction and molar surgery has oral origin, does not affect pharingeal segment and submental-submandibular muscle group. This type of dysphagia has clear EMG signs: increased duration of single swallow, longer drinking time, low range of electric activity of m. masseter, normal range of activity of submental-submandibular muscle group, and the "dry swalow" aftereffect. The data can be used for evaluation of complaints and symptoms, as well as for comparison purposes in pre- and postoperative stages and in EMG monitoring during treatment of post-surgical oral cavity discomfort and dysphagia

Hypoesthesia occurs in acute whiplash irrespective of pain and disability levels and the presence of sensory hypersensitivity

Objectives: In contrast to the increasing knowledge of the sensory dysfunction involved in chronic whiplash associated disorders, the use of comprehensive quantitative sensory testing in the acute stage of the condition is sparse. In this study, we sought to investigate the presence of sensory hypoesthesia in participants with acute whiplash injury. Methods: Fifty-two volunteers within 4 weeks after a motor vehicle accident and 31 healthy asymptomatic volunteers were recruited for this study. We classified our cohort into either a "high-risk" (n=17; signs associated with poor recovery including Neck Disability Index scores >30, cold and mechanical hyperalgesia, heightened brachial plexus provocation test responses) or "low-risk" group (without these signs). Detection thresholds to electrical, thermal, and vibration stimuli measured in lower cervical nerve root innervation zones and psychologic distress and posttraumatic stress symptoms were compared between the groups using multivariate analysis of covariance. Results: Both the high-risk and low-risk groups exhibited significant elevation in sensory detection when compared with controls (P0.05). Both groups were psychologically distressed. Discussion: Our findings demonstrate generalized hypoesthesia in acute whiplash associated disorders suggesting adaptive central nervous system processing mechanisms are involved, regardless of pain and disability. The elevated levels of psychologic distress seen in both groups may also play a role

The development of sensory hypoesthesia after whiplash injury

Objectives: (1) To investigate the development of hypoesthesia from soon after the whiplash injury to 6 months postinjury and (2) to determine differences in detection thresholds between those with initial features of poor recovery and those without these signs. Methods: Fifty-two participants with acute whiplash-associated disorders (WAD) (30; sensory hypersensitivity) or "low risk" (n=35; without these signs). Detection thresholds to electrical, thermal, and vibration stimuli and psychological distress were prospectively measured within 1 month of injury and then 3 and 6 months postinjury. Detection thresholds were also measured in the 38 controls. Results: Both WAD groups showed hypoesthesia (vibration, electrical, and cold) at 1 month postinjury. Vibration and electrocutaneous hypoesthesia persisted to 3 and 6 months only in the high-risk WAD group. Heat detection thresholds were not different between the groups at 1 month postinjury but were elevated in the high-risk group at 3 and 6 months. Both WAD groups were distressed at 1 month but this decreased by 3 months in the low-risk group. The differences in the Impact of Event Scale did not impact on any of the sensory measures. DISCUSSION: Sensory hypoesthesia is a feature of acute WAD but persists only in those at higher risk of poor recovery. These findings suggest the involvement of the central inhibitory mechanisms that may be sustained by ongoing nociception

Whiplash (Grade II)and cervical radiculopathy share a similar sensory presentation: an investigation using quantitative sensory testing

Recent research has identified the coexistence of generalized sensory hypersensitivity and hypoesthetic changes suggestive of a neuropathic component to chronic whiplash associated disorders (WAD). This study aimed to compare chronic whiplash with a cervical neuropathic condition-cervical radiculopathy, using Quantitative Sensory Testing.Fifty participants with chronic grade II WAD (>3 mo), 38 participants with radiculopathy, and 31 controls who were age and sex matched to participants with WAD participated in the study. Quantitative Sensory Testing including detection thresholds (electrical, thermal, and vibration) and pain thresholds (pressure, cold) were measured from bilateral hand sites corresponding to innervation areas of the lower cervical nerve roots and a remote site in the lower limb.The whiplash and cervical radiculopathy groups demonstrated lower pain thresholds to both pressure and cold stimuli at all sites compared with the controls (

Presentation of cysticercosis of the lateral pterygoid muscle as temporomandibular disorder: A diagnostic and therapeutic challenge

Orofacial pain can often be the chief complaint of many systemic disorders. Cysticercosis involving the lateral pterygoids may cause limitation of mouth opening and may mimic clinical symptoms of a temporomandibular disorder. A 37-year-old female presented with 1-month-old complaint of limited mandibular range of motion. She reported a similar episode a year earlier and was diagnosed with a temporomandibular joint disorder by her primary dentist. Comprehensive intra- and extra-oral examinations were performed, which revealed a limitation of mouth opening accompanied by mild limitation of contralateral excursion. A magnetic resonance imaging revealed a ring-enhancing lesion within the left pterygoid muscle suggestive of cysticercosis. The patient was referred to her primary care physician for further treatment and given physical therapy (stretching exercises) to improve mouth opening. One week later, she developed lesions in the arm and trunk. Further ultrasound imaging of the abdomen and the forearms confirmed the diagnosis of cysticercosis. She was treated with albendazole, physiotherapy, joint stabilization appliance, and had eventual complete recovery. This case emphasizes the importance of diagnosis of a systemic condition that may have serious implications, if untreated, and the importance of a comprehensive evaluation, workup, and multidisciplinary management

Mouse model demonstrates strain differences in susceptibility to opioid side effects

Individual differences have been observed in responses to opioid drugs, including common side effects. In this study, the inbred mouse strains A/J and C57BL/6J were used to determine whether their specific strain differences correlate with differences in susceptibility to respiratory depression and constipation. To measure the effects of morphine on respiration, morphine at 15 and 40 mg/kg was injected subcutaneously. Respiratory parameters were then measured 30 and 60 min later. To measure the effects on constipation, 5, 15, 40, and 60 mg/kg doses were administered subcutaneously three times daily for three days. Gastrointestinal transit distance was then measured using the charcoal bolus test. C57BL/6J mice showed a greater degree of change in several respiratory parameters, resulting in more pronounced respiratory depression. C57BL6J mice also showed significantly more constipation than A/J mice with 40 and 60 mg/kg morphine doses. This study demonstrates that the strain differences between A/J and C57BL/6J mice have a major effect on opioid-induced constipation and respiratory depression. These correlations are of great clinical interest, as they could lead to the development of methods for reducing side effects