Differential Diagnostics of Pain in the Course of Trigeminal Neuralgia and Temporomandibular Joint Dysfunction

Chronic oral and facial pain syndromes are an indication for intervention of physicians of numerous medical specialties, while the complex nature of these complaints warrants interdisciplinary diagnostic and therapeutic approach. Oftentimes, lack of proper differentiation of pain associated with pathological changes of the surrounding tissues, neurogenic pain, vascular pain, or radiating pain from idiopathic facial pain leads to improper treatment. The objective of the paper is to provide detailed characterization of pain developing in the natural history of trigeminal neuralgia and temporomandibular joint dysfunction, with particular focus on similarities accounting for the difficulties in diagnosis and treatment as well as on differences between both types of pain. It might seem that trigeminal neuralgia can be easily differentiated from temporomandibular joint dysfunction due to the acute, piercing, and stabbing nature of neuralgic pain occurring at a single facial location to spread along the course of the nerve on one side, sometimes a dozen or so times a day, without forewarning periods. Both forms differ significantly in the character and intensity of pain. The exact analysis of the nature, intensity, and duration of pain may be crucial for the differential diagnostics of the disorders of our interest

The Application of Radiofrequency Waves in Supportive Treatment of Temporomandibular Disorders

In recent years, the number of patients applying for prosthetic treatment due to temporomandibular joint disorders (TMD) has been increasing. The main methods for treating disorders are the use of occlusal splints and physiotherapeutic rehabilitation as supportive treatment. Radio waves are electromagnetic waves with radiation frequency between 3 Hz and 3 THz, used for physiotherapeutic treatment of skeletal muscle relaxation in the range of 3 to 6 MHz. The rehabilitation effect of these waves is based on diathermy by means of high-voltage quick alternating current. Aim. The aim of the study was to evaluate the influence of radiofrequency waves on the pain of the masticatory muscles in the course of TMD and the usefulness of these procedures in the supporting treatment of these disorders. Materials and Methods. Patients aged 19 to 45 years, of both sexes, reported to the Consulting Room of TMD at the Institute of Dentistry in Krakow to undertake prosthetic treatment of TMD (I a—according to RDC/TMD). Study group (SG) consists of 20 patients who had 10 supportive treatments with radiofrequency currents. In the case of application of radiation to the muscle area, the energy was 20 J to the area of the masticatory muscles, the frequency was 3 MHz, bipolar technique, the duration of the procedure was 10 minutes, and the coupling substance was a gel for ultrasound examinations. The control group (CG) consisted of 20 patients who had 10 supportive treatments with sonophoresis procedures. For the area of masticatory muscles, 0.9 W/cm2 treatments were applied, the duty factor was 80%, the treatment time was 10 minutes, and the medical substance was 25% Voltaren gel. Results. Analysis of the results of the first clinical examinations (axis I) conducted in both groups shows a homogeneous clinical material and similar results. The second clinical examination revealed improved clinical parameters, but it showed a greater improvement in the SG. In the SG, the mean level of VAS was 6.25, and the extreme values were 5.9–0.14, the median was 2.15, and the standard deviation was 1.54. In the CG, the average value of VAS was 6.20 (peak of 5.2–0.7), the median was 2.4, and the standard deviation was 1.87. Summary. The search for new methods of supportive treatment of TMD is an important research direction due to the complex etiology of this disease and the lack of an explicit treatment algorithm. Conclusion. The results of our own research clearly indicate that the use of the radiofrequency waves brings pain relief and improvement of clinical parameters to a greater extent than in sonophoresis. It can be a very important new method in supportive treatment of TMD. Research needs to be continued

Badania tribologiczne biomateriałów warstwowych na konstrukcje protetyczne o podbudowach z technologii cyfrowych

Modern dental prosthetics uses CAD/CAM in the Computer Aided Design (CAD) of substructures and its Computer Aided Manufacturing (CAM) process. The substructure is subject to appropriate veneering, which determines the functional cooperation. The aim of this study is to investigate the friction coefficient and wear resistance of the veneering layers of the substructures of prosthetic structures. The test materials are dedicated veneering layers on substructures made of factory-made CoCr, TiCP, and Ti6Al4V metal fittings as well as the glass-ceramic material LiSi2 and the ceramic ZrO2. The study was conducted on a Roxana Machine Works tribological machine in the ball-and-3discs system in an artificial saliva environment using a Hitachi S3400 scanning microscope. As a reference biomaterial, enamel-dentin discs were used. The tribological processes that take place under chewing conditions in the presence of saliva depend on the properties and technological parameters of the surface layer of the biomaterial wearing out and on the enamel of opposing teeth in contact, which also wears out. They should reproduce the physiological nature of adjustment wear in the stomatognathic system (SS). The determined values of the friction coefficient and wear resistance allowed differences to be indicated in the course of tribological processes, and microscopic analyses confirmed them.Współczesna protetyka stomatologiczna wykorzystuje system CAD/CAM do cyfrowego projektowania podbudowy konstrukcji (CAD) oraz do jej wytwarzania w sterowanym numerycznie procesie (CAM). Podbudowa nośna poddawana jest odpowiedniemu licowaniu, które decyduje o funkcjonalnej współpracy. Celem pracy jest badanie współczynnika tarcia i odporności na zużycie warstw licujących podbudowy konstrukcji protetycznych. Materiałem badań są dedykowane warstwy licujące na podbudowach wykonanych w technologii frezowania z fabrycznych kształtek z metali – CoCr, TiCP i Ti6Al4V oraz z materiałów szklano-ceramicznych LiSi2 i ceramicznych ZrO2. Badania wykonano na maszynie tribologicznej Roxana Machine Works w układzie kula-3krążki w środowisku sztucznej śliny oraz na mikroskopie skaningowym Hitachi S3400. Jako biomateriał referencyjny wykorzystano krążki szkliwno-zębinowe. Procesy tribologiczne, które zachodzą w warunkach żucia w obecności śliny uzależnione są od właściwości i parametrów technologicznych warstwy wierzchniej zużywającego się biomateriału oraz od szkliwa zębów przeciwstawnych wchodzących w kontakt, które również się zużywają. Powinny odtwarzać fizjologiczny charakter zużycia dostosowawczego w układzie stomatognatycznym (US). Wyznaczone wartości współczynnika tarcia i odporności na zużycie pozwoliły na wskazanie różnic w przebiegu procesów tribologicznych, a analizy mikroskopowe to potwierdziły

Botulinum neurotoxin type A for the treatment of pain: not just in migraine and trigeminal neuralgia

BACKGROUND: Despite their huge epidemiological impact, primary headaches, trigeminal neuralgia and other chronic pain conditions still receive suboptimal medical approach, even in developed countries. The limited efficacy of current pain-killers and prophylactic treatments stands among the main reasons for this phenomenon. Botulinum neurotoxin (BoNT) represents a well-established and licensed treatment for chronic migraine, but also an emerging treatment for other types of primary headache, trigeminal neuralgia, neuropathic pain, and an increasing number of pain conditions. METHODS: We searched and critically reviewed evidence for the efficacy of BoNT for the treatment of chronic pain. RESULTS: Meta-analyses and randomized controlled trials (RCTs) suggest that BoNT potentially represents a multi-purpose drug for the treatment of pain in several disorders due to a favorable safety profile and a long-lasting relief after a single injection. CONCLUSIONS: BoNT is an emerging treatment in different pain conditions. Future RCTs should explore the use of BoNT injection therapy combined with systemic drugs and/or physical therapies as new pain treatment strategies