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This study was conducted to identify oral health factors that are important to people who are elderly. By identifying factors valued by patients who are older, dental professionals can gain better insights into the preferences and priorities that patients use in making dental treatment decisions. To determine which factors are important to this population, we compiled a list of oral health goals identified through a literature review. To supplement this initial list, we undertook line-by-line (open) coding of transcripts of two sets of semi-structured interviews. The first set of interviews explored the decision of older adults to seek treatment in response tooth pain. The second set of interviews elicited anticipated responses to three scenarios involving extensive restoration and one scenario involving extraction and prosthetic replacement among older patients at a dental school.

Objectives: To assess the impact of oral health on the life quality of a periodontal patient group., Materials and Methods: Two hundred and five patients attending a private periodontal clinic completed a questionnaire incorporating the 16-item UK oral health-related quality-of-life measure (OHQoL-UK), a check list of questions about their periodontal health over the past year and a comprehensive periodontal examination., Results: The effect of oral health on quality of life was considerable, with many individuals experiencing negative impacts across a broad range of physical, social and psychological aspects of life quality. OHQoL-UK(Copyright ) scores was associated with patient's self-reported periodontal health in the past year: experiences of "swollen gums" (p<0.01), "sore gums" (p<0.01), "receding gums" (p<0.01), "loose teeth" (p<0.01), "drifting teeth" (p<0.01), "bad breath" (p<0.01) and "toothache" (p<0.01). In addition, OHQoL-UK scores were correlated with the number of teeth with pocket depths of 5 mm or more (r(s)-0.42, p<0.01). New patients had poorer oral health-related quality of life compared with the treated maintenance group (p<0.01)., Conclusions: Periodontal status impacts on life quality. This has implications in understanding the consequences of periodontal health and in the use of patient-centred outcomes in periodontal research.

The objective of this study was to compare the analgesic efficacy of tramadol/acetaminophen (APAP) (total dose 75 mg/650 mg) and tramadol (total dose 100 mg) for the control of pain after oral surgery. A total of 456 patients with moderate-to-severe pain within 5 h after extraction of two or more third molars were randomized to receive two identical encapsulated tablets containing tramadol/APAP 37.5 mg/325 mg, tramadol 50 mg, or placebo. Tramadol/APAP was superior to tramadol (P < 0.001) or placebo (P < 0.001) on all efficacy measures: total pain relief (PAR) over 6 h (7.4, 2.5, and 1.5, respectively, on a scale of 0-24); sum of pain intensity differences (PIDs) (3.1, 0.6, and 0.1, respectively, on a scale of -6 to 18); and sum of PAR and PID (10.5, 3.1, and 1.6, respectively, on a scale of -6 to 42). Median times to onset of perceptible and meaningful PAR were 37.6 and 126.5 min, respectively, for the tramadol/APAP group (P < 0.001) for each, compared with tramadol and placebo arms). The most common adverse events with active treatment were nausea, dizziness, and vomiting; these events occurred more frequently in the tramadol group than in the tramadol/APAP group. This study established the superiority of tramadol/APAP 75 mg/650 mg over tramadol 100 mg in the treatment of acute pain following oral surgery.

The aim of the present study was to analyze whether previously emerged pain symptoms and painless temporomandibular disorder (TMD) symptoms are associated with alexithymia and self-rated depression among media personnel in or not in irregular shift work. A standardized questionnaire was mailed to all employees of the Finnish Broadcasting Company in irregular shift work (n = 750) and to an equal number of randomly selected controls in regular 8-h daytime work. The questionnaire covered demographic items, employment details, general health experience, physical status, psychosomatic symptoms, psychosocial status, stress, work satisfaction and performance, and health-care use. Studied age groups, marital status, gender or perceived health were not significantly associated with alexithymia in the bivariate analyses. Most studied painless TMD symptoms associated significantly with alexithymia. Alexithymia was also significantly more prevalent among those who reported having more often than average neck pain (P < 0.05), head pain (P < 0.05), and tender teeth (P < 0.01). According to logistic regression, the probability of alexithymia was significantly positively associated with pain symptoms (P < 0.05) and painless TMD-related symptoms (P < 0.01), and significantly negatively associated with female gender (P < 0.01). Additionally, depressive mood was significantly positively associated with dissatisfaction of one's work-shift schedule (P < 0.05), and poorer health experience (P < 0.01). Neither alexithymia nor depression was associated with irregular shift work in itself. In conclusion, depressive mood may be a sign of dissatisfaction and impaired well-being. In the case of perhaps less disabling but common physical symptoms alexithymia as a possible underlying factor may be relevant in the diagnosis and management of such disorders.

Aim: To examine two types of orthodontic separators, focusing on the separating effect and patients' perception of pain and discomfort., Methods: The separators tested were spring-type and elastomeric separators. Thirty teenagers participated, and all were scheduled for treatment with a fixed orthodontic appliance. Two spring-type and two elastomeric separators were placed alternately in the left or the right quadrant. After a separation period of 5 days, the amount of separation was measured with a leaf gauge. Nine questionnaires with visual analogue scales and questions with fixed answers were used to register the patient perceptions., Results: The mean separation was 0.3 mm for the spring-type and 0.4 mm for the elastomeric separators (P < .05). The springs were considered less painful than the elastomerics, but the difference was not statistically significant. For both separators, the pain was worst at day 2 and subsided almost completely by day 5. Due to pain, 14 of the 30 patients changed their food habits, and 13 took analgesics., Conclusions: The separation effect of the two separators was considered clinically equivalent and since pain of moderate intensity occurs during the separation period, analgesics and soft food can be recommended.

Unlabelled: Substantial research suggests that coping strategies, especially catastrophizing, play an important role in shaping adjustment to chronic pain. Although laboratory and clinical studies both suggest that catastrophizing enhances pain, the interaction of catastrophizing and clinical pain on pain sensitivity has received little attention. The present study evaluated the extent to which catastrophizing influenced laboratory thermal pain responses during and after the resolution of acute dental pain. Thermal pain threshold and tolerance, as well as self-reported catastrophizing, were determined in 46 dental patients (15 men and 31 women) experiencing pain as a result of acute pulpitis. All subjects participated in 2 experimental sessions; the first took place immediately before endodontic treatment for relief of pulpal pain, and the second session occurred when patients were pain free, approximately 1 to 2 weeks later. Thermal pain thresholds increased on resolution of acute dental pain, whereas levels of catastrophizing did not change from pretreatment to post-treatment. Catastrophizing was unrelated to thermal pain responses in the presence of acute dental pain (ie, during the first session). Once patients were pain free, catastrophizing showed significant inverse associations with measures of thermal pain threshold and tolerance. In addition, catastrophizing was a robust predictor of changes in thermal pain responses across sessions, with higher baseline catastrophizing predicting reductions or relatively smaller increases in pain threshold and tolerance after successful treatment of acute pain. These data suggest that catastrophizing is prospectively associated with enhanced sensitivity to and reduced tolerance for thermal pain. The use of catastrophizing as a coping strategy might interfere with the resolution of sensitization after cessation of an acutely painful condition, or it might be associated with magnified experimental pain responses across time., Perspective: The findings of the present study suggest that, in some instances, different ethnic groups and genders may use the same descriptors to report different levels of pain. In the context of clinical pain assessment, it may be important to consider the possibility that descriptions of painful sensations reflect, in part, demographic characteristics., (Copyright 2004 American Pain Society)

Objective: This study determined the validity of a Hebrew version of the Oral Health Impact Profile in a cross-sectional study of a general dental practice in Israel., Methods: The original English version of a short-form oral health impact profile (OHIP-14) was translated into Hebrew using the back-translation technique. Participants were interviewed and examined clinically by a calibrated dentist. Information on the subjects' sociodemographic background and oral health conditions was collected., Results: A total of 142 persons were interviewed and clinically examined. The Cronbach's alpha and the standardized item alpha for OHIP-14 were both 0.88. Cronbach's alpha of the translated OHIP-14 subscales ranged from 0.48 to 0.76. Construct validity of the translated Hebrew version was supported by the finding that the total OHIP score correlated with the number of decayed teeth, missing teeth, need for prosthodontic treatment, and pattern of dental attendance. Participants with oral pain were more likely to report impact on one of the OHIP subscales and to have more impacts than participants who were pain free., Conclusions: The Hebrew version of OHIP-14 presented acceptable validity and reliability. Further research is needed to assess the value of this measure in Israel.

Authors describe a 58-sitting psychotherapy of a 46-year-old female patient with psychogenic atypical facial pain. Sexual trauma in the childhood was found as a cause of the psychogenic pain symptoms, leading to series of unnecessary extraction of teeth in this case. Psychotherapeutic treatment led to the recovery of the somatic symptoms, and a moderate improvement of the behaviour related to men of this patient.

Objective: Previous studies have noted a discrepancy between clinically determined oral health status (normative need), patients' perceptions, and perceived significance of dental signs and symptoms. Our objective was to quantify the relationships between normative need and self-reports to improve our understanding of the factors that contribute to perceived need for care., Methods: Clinical examination and questionnaire data were derived from the Florida Dental Care Study, a study of oral health and dental care, in a representative sample of community-dwelling adults aged > or = 45 years. The questionnaire provided information about presence of signs and symptoms, self-ratings of oral health, perceived need for dental care, and sociodemographic status (SDS). Perceived need was measured on a 4-point nominal scale., Results: Self-reported broken filling, broken denture, cavities, loose tooth, teeth that look bad, and toothache were strongly associated with self-reported perceived need for dental care. Satisfaction with dental health was also associated with perceived need, but self-rated oral health was not. Most measures of SDS were associated with perceived need. However, in a single multiple regression, with self-reported signs and symptoms accounted for, race, age group, sex, and educational attainment were not significantly associated with a currently perceived dental problem., Conclusions: Certain dental signs and symptoms were significantly associated with perceived need for dental care, as were certain aspects of SDS; even once differences in dental signs and symptoms had been taken into account. Disaggregating measurement of perceived need from a single dichotomous ('yes/no') scale to a 4-point nominal scale was elucidative.

Purpose: The purpose of this study was to investigate the effects of early childhood caries (ECC) on children's oral health-related quality of life (QOL) before and 4 weeks after its treatment, as assessed by the children themselves as well as by their parents/guardians., Methods: This study had a longitudinal intervention design. Sixty-nine children diagnosed with ECC and 43 children without caries (combined children's mean age=50.4 months; range=22 to 70 months) and their parents/guardians responded to face-to-face administered surveys before a dental treatment was started (baseline assessment). Thirty-seven children with ECC completed dental rehabilitation. Four weeks after the treatment was completed, these 37 children as well as their parents/guardians responded to a second survey (follow-up assessment)., Results: The results show that children with ECC have significantly lower oral health-related QOL than children without ECC as assessed both by the children and the parents/guardians at baseline. The children with ECC who received dental treatment had a significantly improved oral health-related QOL at the follow-up assessment when compared with their baseline measurement as measured both with the children's self-ratings of oral health-related QOL and the parents'/guardians' perception of their child's oral health-related QOL., Conclusions: ECC and its treatment affect children's oral health-related QOL in a significant way. Oral health-related QOL can be assessed validly and reliably both in self-reports from children as young as 36 months of age as well as by asking parents/guardians about their perceptions of their child's oral health-related QOL.

Objectives: The purpose of this study was to investigate if a change in the social gradients in perceived oral health occurred over a 5-year period, 1992-97, using a cohort population from two Swedish counties., Methods: In 1992, a cross-sectional mail questionnaire was sent to all 50-year-old persons in two counties in Sweden, Orebro and Ostergötland, and altogether there were 8888 persons. In 1997, the same population was sent a new questionnaire. The cohort, comprising the same respondents from 1992 and 1997, was of 5363 persons. An index of perceived oral health was constructed out of three questionnaire variables: satisfaction with teeth, chewing ability and the number of remaining teeth. This index value was set as a dependent variable in a regression model. Reports of toothache were investigated in a separate logistic regression model., Results: There were obvious social gradients in the perceived oral health index both in 1992 and in 1997. Marital status, foreign birth, education and occupation were all substantially related to the perceived oral health. The change in perceived oral health was analyzed. Almost half of the cohort (47.4%) showed no change at all. Those with increased and those with decreased health were rather evenly distributed on both sides, with 22.0% with better health in 1997 and 30.6% with worse health. Gender and education were related to toothache experience., Conclusion: Changes have been moderate in the perceived oral health in this cohort, despite the rather drastic changes in the remuneration of dental care during this study time. On the other hand, this also means that the social differences remain, despite the official goals of increased equity.

Objective: To understand from the patient's perspective the types of dental problem which present at weekends, how they affect people, and the care-seeking behaviour of emergency dental patients., Basic Design: Consecutive patients attending two emergency dental clinics at weekends were interviewed prior to seeing the dentist. The audio-recorded interview transcripts were analysed using the "framework" method of applied qualitative data analysis., Setting: A community-based and a dental hospital emergency dental clinic., Subjects: 44 emergency dental patients., Results: Pain was the main presenting symptom, a key domain of quality of life and the underlying cause of most other quality of life effects. However, for patients deciding what symptoms mean--crucially whether they mean they need to see a dentist urgently--a wide range of other contextual factors come into play. These go beyond the individual patient's recent and current perception of symptom intensity. They encompass past experience of similar symptoms, past care-seeking experiences, anticipated effects on quality of life, anticipated service availability, joint decision-making and lay information from family and friends, professional opinions from non-dentists, expectations concerning what work dentists should do, and what symptoms distinguish "simple toothache" from more serious problems., Conclusions: The effects of, and meanings which people attach to, acute dental symptoms are complex. Combined with poor awareness of the existence of emergency dental services it is not surprising that patients' pathways to care are correspondingly complicated. The planning of emergency dental services should be based on a broader, patient-derived understanding of the need for them.

The efficiency of infiltration, conduction, and intraligamental anesthesia with different anesthetics for oral therapeutic interventions was evaluated in 331 patients without concomitant somatic diseases. The levels of reactivity and personal anxiety, as well as the patient's mood have an essential impact on their own appraisal of the quality of analgesia, which the dentist should bear in mind when planning and carrying out anesthesia. Mean and high levels of anxiety are characterized by decreased subjective confidence in the quality of analgesia and can mislead the dentist, if he/she neglects these characteristics.

The psychological effects of tooth loss in the permanent dentition are relatively unknown. Complete edentulousness is a serious life event in terms of readjustment. The aim of the study was to describe the process patients with deteriorating dental status had gone through before treatment with a fixed prosthesis (Brånemark System, Novum), and to describe what living with a fixed prosthesis means to the patients themselves. In-depth interviews were carried out with 18 patients, and the interviews were transcribed verbatim and analysed in open, axial and selective coding processes according to Grounded Theory. In the analysis, four categories were developed and labelled: 'alterations in self-image', 'becoming a deviating person', 'becoming an uncertain person' and 'becoming the person I once was'. 'Alterations in self-image' was identified as the core category and was related to the other three categories. The core category describes the changes in self-image starting with the subjects' increasingly worsened dental status, followed by a period of them having to live and cope with a denture and, finally, their living with a fixed prosthesis. The motive power for the decision to undergo treatment with a fixed prosthesis seems to be a desire to restore dental status and also to recapture attractiveness, self-esteem and a positive self-image.

This selection of literary extracts deals with the subject of toothache from the point of view of the sufferer. Circumstances, effects and remedies, orthodox and otherwise, are described.

Objectives: This paper estimates the incidence of oral disadvantage based on the subject's approach to dental care, sex, race, and financial status; identifies demographic and socioeconomic characteristics that were associated with oral disadvantage; and determines if these characteristics were differentially associated with the three domains of oral disadvantage., Methods: The Florida Dental Care Study was a longitudinal study of oral health in diverse groups of persons who at baseline had at least one tooth, were 45 years or older, and were either African American or non-Hispanic white. Incidence rates, odds ratios, and 95 percent confidence intervals were used to describe oral disadvantage and its relation to race, income, and other key sociodemographic characteristics., Results: The strongest independent predictors of oral disadvantage were approach to dental care (problem-oriented attenders or regular), and situation if faced with an unexpected $500 dental bill. Demographic and socioeconomic characteristics were differentially associated with each disadvantage domain., Conclusions: African Americans, females, rural residents, individuals who did not graduate from high school, individuals with limited financial resources, and problem-oriented dental attenders had significantly higher occurrences of oral disadvantage. Racial and sex disparities in oral disadvantage were largely explained by differences in approach to dental care and financial resources between these groups.

The objective of this study was to determine whether patients with phantom tooth symptoms have an altered sensory perception as compared to pain-free subjects. Ten patients (mean age 56, range 32-71, nine females) were diagnosed as suffering from "phantom tooth" according to a specifically designed phantom tooth questionnaire including components of the McGill Pain Questionnaire. An SCL-90 form was completed and assessment of sensory perception was carried out by determination of the threshold level for light touch sensation, two-point discrimination, and thermal sensation in a case-control design. Results. Of all the observed questionnaires, 5.7% seemed to deal with phantom tooth, with a female preponderance (ratio 9:1). Complaints were predominantly reported in the upper jaw (ratio 8:2) with the majority in the molar region (ratio 5:3). Phantom tooth subjects showed significantly lower threshold levels for light touch sensation, most markedly on the affected side. The average psychoneurotic profile showed a tendency towards higher scores for the phantom tooth subjects. Conclusion. The phantom tooth phenomenon may show a number of features which might aid differential diagnosis. To verify influences such as upper molar predominance and increased light touch sensation, another study should be performed on a larger patient sample.

This research analyzes transcripts of semi-structured interviews with patients presenting with tooth pain at a rural dental clinic in North Florida. The primary objectives are to identify the strategies patients use to manage their pain and to elucidate the decision-making process leading to the clinic visit. Although respondents understood that their condition was not self-limiting, only about one-half contacted the clinic within several days of the onset of their pain. Most tried one or more lay management strategies.

Toothache is a subjective oral health indicator that should become uncommon when oral health is improving. The aim of this study was to assess changes in perceived toothache between 1977 and 1997 among Finnish adolescents. In the Adolescent Health and Lifestyle Survey, a self-administered questionnaire was mailed to a representative sample of 12-, 14-, 16-, and 18-year-old Finns every second year. The sample sizes in the surveys varied from 2422 to 11,105, making a total of 35,349 subjects in the entire study. The incidence of toothache during the previous 2 years was requested in 1977, 1985, 1991, 1995, and 1997, and the prevalences were 31%, 25%, 28%, 29%, and 37%, respectively. The increase between 1995 and 1997 was highest among 16- and 18-year-olds. There was no tendency for perceived toothache to decline over the study period, despite the decrease in caries experience. Toothache varied by age, socioeconomic status (SES), place of residence, and toothbrushing frequency. The increase in the incidence of toothache reported after 1995 could be a warning signal that economic recession in Finland has caused changes in the dental care system.

Aims: To explore the subjective experience of a sample of patients attending a dental teaching hospital emergency clinic with toothache., Materials and Methods: Subjects 21 female and 14 male dental patients, of different ages, marital status, employment status and levels of education, presenting with toothache at a dental teaching hospital emergency clinic. Data collection Unstructured in-depth interviews, following a topic guide. Analysis Transcribing, sifting, indexing and charting data according to key issues and themes., Findings: A dimension of toothache pain that emerged was the perceived inability to cope. Patients reported a dependency on a dentist or other person to alleviate their pain, suggesting connotations of helplessness, disempowerment and incapacitation. The perceived inability to cope was also expressed in terms of loss of control, despair and isolation. A number of care-seeking patterns for toothache was identified: repeated visits to the same dentist for emergency care, repeated visits to different dentists, attendance at the dental hospital emergency clinic and consulting non-dental health workers such as doctors and pharmacists., Conclusions: The perceived inability to cope and care-seeking patterns are two unexplored dimensions of the toothache pain experience. Both dimensions may be associated with pain intensity, the clinical conditions that manifest as toothache, quality of treatment provided and management of demand for emergency dental care. A conceptual framework is proposed for future research to investigate these relationships.

Aim: Studies of the descriptions of pain by children have neglected their linguistic development, therefore estimates of dental pain in children may not be accurate. This study sought (1) to identify words chosen by children to describe dental pain and (2) to establish the effect of linguistic development on that description., Sample: Seventy-eight consecutive children between the ages of 5 and 13 years attending a paediatric dental clinic., Method: Each child completed the WORD reading comprehension test. They then underwent a pulp test and a simulated pulp test, administered by a dentist in a counterbalanced order, of a healthy primary canine or permanent incisor, according to the child's age. To describe each test, the children had to (1) select words from a list of 58 read by the experimenter and (2) give ratings on scales representing 'sore' and 'tingly'., Results: Analysis of variance confirmed that the children chose more words for the pulp test than for the simulated test (P < 0.001); the former also elicited higher ratings for 'sore' and 'tingly'. The numbers of words chosen were transformed by a square root constant to ensure a normal distribution. Multiple regression analysis then showed that (1) the better the children's reading comprehension, the fewer words they chose, possibly because they were less inclined to choose unfamiliar words, and (2) the older they were, the more words they chose, possibly because of having more experience of pain. There were similar findings for ratings of 'sore' and 'tingly'., Conclusions: To assess children's experience of pain (1) they need to be presented with a list of words like the ones in this study, (2) the numbers of words chosen by them would represent the severity of pain, and (3) those numbers need to be adjusted for the children's reading comprehension and age.

Toothache is a common complaint in the dental office. Most toothaches have their origin in the pulpal tissues of periodontal structures. These odontogenic pains are managed well and predictably by dental therapies. Non-odontogenic toothaches are often difficult to identify and can challenge the diagnostic ability of the clinician. The most important step toward proper management of toothache is to be suspicious that the pain may not be of dental origin. The cardinal warning symptoms of non-odontogenic toothache are as follow: A. Spontaneous multiple toothaches. B. Inadequate local dental cause for the pain. C. Stimulating, burning, non-pulsatile toothaches. D. Constant, unremitting, non-variable toothaches. E. Persistent, recurrent toothaches. F. Local anesthetic blocking of the offending tooth does not eliminate the pain. G. Failure of the toothache to respond to reasonable dental therapy.

Objective: Considerable research suggests that females exhibit greater sensitivity to laboratory pain procedures than do males; however, whether the presence of acute clinical pain influences this sex difference in pain sensitivity has not been investigated. The present experiment investigated the effects of sex and acute dental pain on laboratory pain responses., Design: Thermal pain onset and tolerance were determined in 46 dental patients (15 male, 31 female) experiencing pain due to acute irreversible pulpitis and in 33 healthy controls (13 male, 20 female). In addition, measures of mood and coping were obtained in all participants. All subjects participated in two experimental sessions. The first session took place immediately before the patients underwent endodontic treatment for relief of pulpal pain. The second session took place approximately 1-2 weeks later, when pulpitis patients were pain free after treatment. During each session, thermal pain onset and tolerance were assessed with a 1-cm2 contact thermode applied to the right volar forearm using an ascending method of limits., Results: During both sessions, thermal pain onset and tolerance were lower in control females than in control males; however, male and female pulpitis patients did not differ in their thermal pain responses during either session. Pulpitis patients also showed greater affective distress than controls., Conclusions: These data suggest that the sex difference in thermal pain sensitivity frequently reported in pain-free subjects appears to be absent in patients presenting with acute dental pain. However, this effect cannot be explained solely based on the presence of clinical pain because the effect on pain threshold and tolerance persisted into session 2, when pulpitis patients were pain free. Potential explanations for these results are discussed.

The aim of this survey was to assess the present state of dental health knowledge, attitudes/behaviour and perceived oral health of Japanese employees. A 60-item questionnaire was used in a dental health project in the work place. The subjects comprised 77,845 employees, 76 per cent of whom reported delaying a dental visit until they had toothache, with about 60 per cent delaying even when they discovered a decayed tooth. The majority did not regard decayed teeth as a disease and only a minority reported regular dental visits. About three quarters reported bleeding gums on brushing, although more than half had never been taught professionally how to clean their teeth and less than 5 per cent flossed daily. More than half believed that false teeth were inevitable in old age, and that their teeth were getting worse despite daily brushing. About 70 per cent of the employees thought that it was impossible to prevent gum disease with toothbrushing alone, and nearly half believed a toothpaste with fluoride was effective in preventing periodontal disease. Reorientation of oral health care in Japan, therefore, is urgently needed and dental services have to be provided for the implementation of systematic oral health promotion for employees in the workplace.

This study investigated sex differences in orofacial pain symptoms in a sample of elderly adults. Furthermore, differences across sex were tested on symptom continuity, overall duration, pain severity, activity reduction, and health care utilization, related to each specific symptom. Telephone interviews were conducted with a stratified random sample of community dwelling older (65+) north Floridians. A total of 5860 households were contacted and screened, with 75.3% participating to the point where their eligibility for the study could be determined. Of the remaining households, 1636 completed the interview. Of the total sample, 17.4% reported experiencing at least one of the four target orofacial pain symptoms (jaw joint pain, face pain, oral sores, burning mouth) during the past year, suggesting that orofacial pain symptoms are common in older adults. Our findings for prevalence of each specific symptom (jaw joint pain, 7.7%; face pain, 6.9%; oral sores, 6.4%; toothache, 12.0%; burning mouth, 1.7%) are similar to those estimated by the 1989 National Health Interview Survey, for the US adult population. Consistent with other epidemiological and clinical studies, we found that females were more likely to report jaw joint pain and face pain than males. In contrast to clinical studies, no differences were found on subjective ratings of pain severity, for any symptom. Differences across sex were most likely to be reported for jaw joint pain related variables, suggesting undetermined sex-uniqueness for these symptoms. In contrast to previous studies, older females tended to report lower levels of health care utilization than older males. This is the first study to our knowledge that reports orofacial symptom-specific sex differences among the elderly.

Variability in the assessment methods of patients seeking treatment for musculoskeletal disorders of the masticatory system confounds comparative assessment of different studies. In this study, presenting symptom profiles were assessed in 40 Australian and 42 Finnish patients with temporomandibular disorders. The symptom parameters of these patients were compared with those of 40 Australians reporting acute dental pain and were assessed with reference to response to conservative management. A self-administered anamnestic questionnaire was used in a standard, systematic, and comparative way to assess demographic data, general health status, and symptom parameters according to type, frequency, severity, duration, location, impact on the patients' lives, urgency for need of treatment, and possible initiating factors. It was found that the two nationalities studied had similar presentations of cardinal symptom profiles. Statistically significant differences in major presenting symptoms were found between patients with temporomandibular disorders and those with acute dental pain, but not between patients who responded rapidly as opposed to slowly to conservative therapy. It was concluded that the presenting symptom profiles were similar for the two nationalities and were not related to treatment outcome.

The aim of this study was to investigate the relation between some 'lifestyle' factors and motivation for toothbrushing in young people. Data from a questionnaire survey of 7770 children aged 14-15 years were analysed to obtain information about their main reason for toothbrushing, their toothbrushing frequency, smoking behaviour and social efficacy. In those who brushed their teeth less frequently, toothbrushing was performed more for cosmetic reasons, that is, having teeth that look and feel good and breath that smells fresh, in contrast to the avoidance of toothache and false teeth, which are health reasons. The more socially advantaged individuals were more inclined to brush their teeth to avoid toothache, and less for the sake of good appearance, compared with the more disadvantaged. Motivation for toothbrushing varied significantly with smoking behaviour, committed smokers were more inclined to brush for cosmetic reasons whereas those who had never smoked were more concerned to avoid dental problems. Similarly, those who had a current friend of opposite sex, and in males, those expressing confidence when meeting members of the opposite sex, brushed more for cosmetic reasons. In conclusion, different people perform their dental hygiene for quite different reasons. These findings need to be taken into account when instructing patients in personal dental care and formulating dental health messages.

Dentists are trained to provide treatment for patients with straightforward problems that respond to routine therapy and do not recur. However, patients may present to dentists and complain solely of physical symptoms such as toothache, headache, and facial pain: only after much inappropriate treatment these symptoms are revealed to be due to emotional disturbance. The dentist may spend hours investigating such patients, in some of whom dental pathology may be present, but the symptoms and ensuing disability cannot be satisfactorily explained as a result. There are other patients who are preoccupied by physical symptoms or by their appearance. In others, anxiety may manifest itself as a phobia, or a dysmorphic concern about certain aspects of their appearance. This article reviews the role of liaison psychiatry and psychology in dentistry.

Although change is a central goal of oral health care interventions, little attention has yet been paid to change in self-perceptions of oral health status. This is an important omission, given the current emphasis on assessing health outcomes. This paper reports the results of a study which examined changes over a period of three years in self-perceived oral health among 611 community-dwelling Canadians aged 50 years and over. Change in self-perceptions was measured by means of a global transition item and change scores derived from repeat administrations of four subjective oral health status indicators. Overall, 20.5% reported that their oral health had deteriorated over the three-year observation period, 68.5% that it had remained the same, and 10.5% that it had improved. There was a significant association between these global change categories and change scores for the four subjective indicators. Because of the small number of edentulous subjects, the analysis of baseline characteristics predicting change was confined to dentate subjects. Bivariate and logistic regression analyses were used to compare the two groups reporting change with those whose oral health status remained stable over the observation period. The results suggest that, when compared with this reference group, those who deteriorated and those who improved were similar in some respects but distinct in others. Those who improved appeared to have specific oral conditions at baseline causing pain. Those who deteriorated had poor oral health in general and came from more disadvantaged backgrounds. However, the explanatory power of logistic regression models predicting change in self-perceived oral health was poor when judged in terms of model sensitivities. This was to be expected, given that the models did not include variables documenting the incidence of disease, receipt of dental care, or changes in social and personal circumstances over the observation period.

A quantitative method for validating qualitative interview results and checking sample parameters is described and illustrated using common pain descriptions among a sample of Anglo-American and mandarin Chinese patients and dentists matched by age and gender. Assumptions were that subjects were members of a sociocultural group (e.g. ethnic or professional/lay) and answered questions independently about a monotonic domain (e.g. pain). Subjects answered 18 true/false items derived from and selected to reflect pain perceptions consistent with published and unpublished interview data. Estimates of consistency in use of descriptors within groups, validity of description, accuracy of individuals compared with others in their group, and minimum required sample size were calculated using Cronbach's alpha, factor analysis, and Bayesian probability. Ethnic and professional differences within and across groups were also tested using multidimensional scaling (MDS) and hypothesis testing. Consensus (consistency of subject response by group) was .99 among Anglo-Americans and .97 among Chinese. Mean subject accuracy was .81 for Americans and .57 for Chinese, indicating the need for larger numbers of Chinese to supplement each others' statements. However, larger numbers of subjects were recruited than actually required for each ethnic group at .95 confidence limits. MDS showed similarities in use of descriptors within ethnic groups, while there were differences (p < .001) between Chinese and American groups. Use of covalidating questionnaires that reflect results of qualitative interviews are recommended in order to estimate sample parameters such as intersubject agreement, individual subject accuracy, and minimum required sample sizes.

Objective: The medical literature suggests that alcoholics may present greater challenges to achieving clinical pain control than nonalcoholics. This study was undertaken to test the hypotheses that: (1) significant differences exist between alcoholics and nonalcoholics on detection and pain thresholds during electric tooth stimulation; (2) group differences exist in the depth and time course of pulpal anesthesia; and (3) responses to tooth stimulation are associated with severity of alcoholism and/or other psychological factors., Method: Male alcoholics (n = 22) in aftercare treatment (mean length of sobriety = 113 days) and age-matched nonalcoholics (n = 22) received 1.0 ml of 3% mepivicaine at the apex of a maxillary lateral incisor and saline placebo at the apex of the contralateral incisor., Results: At baseline no group differences were found on sensory thresholds. During drug intervention significant drug and time effects for both detection threshold (p < .0001) and pain threshold (p < .0001) were found, but group differences and interactive effects were not significant. By exploratory regression analysis of alcoholic subjects, history of depression/unhappiness was significantly associated with shallower pulpal anesthesia, whereas high need for control/low actual control and frequency of treatment for detoxification were associated with deeper anesthesia., Conclusions: Our findings suggest alcoholics in recovery are not at increased risk for inadequate pain control with local anesthesia.

Recent recommendations regard musculoskeletal disorders of the masticatory system as dual-axis disorders, but little comparative data of psychologic factors across different pain populations are available. In this study, presenting psychologic profiles were assessed in 40 Australian and 42 Finnish patients diagnosed with temporomandibular disorders. Findings were compared with those of a group of Australian patients reporting acute dental pain and with reference to response to conservative management. The psychologic testing instrument incorporated cognitive, motivational/affective, and illness behavior variables, and it was based on validated general pain questionnaires (Coping Strategies Questionnaire and Illness Behavior Questionnaire). This instrument was found internally reliable in the majority of its subscales in the group studies and provided comparable data to other pain populations. Significant differences in the presenting psychologic profiles were found according to nationality, type of pain suffered, and treatment outcome. Affective disturbance, hypochondriasis, lack of cognitive control, and feeling ill with symptoms were identified in discriminant function analysis as potential predictors of treatment outcome, and they correctly classified 79% of the Australian and 87% of the Finnish patients with temporomandibular disorders. It was concluded that psychologic profiles differed in the two nationalities and were related to treatment outcome. The concept of multiaxial assessment was supported.

The aim of the study was to measure incidence of oral impacts on daily performances and their related features in a low dental disease population. 501 people aged 35-44 years in 16 rural villages in Ban Phang district, Khon Kaen, Thailand, were interviewed about oral impacts on nine physical, psychological and social aspects of performance during the past 6 months, and then had an oral examination. The clinical and behavioural data showed that the sample had low caries (DMFT = 2.7) and a low utilization of dental services. 73.6% of all subjects had at least one daily performance affected by an oral impact. The highest incidence of performances affected were Eating (49.7%), Emotional stability (46.5%) and Smiling (26.1%). Eating, Emotional stability and Cleaning teeth performances had a high frequency or long duration of impacts, but a low severity. The low frequency performances; Physical activities, Major role activity and Sleeping were rated as high severity. Pain and discomfort were mainly perceived as the causes of impacts (40.1%) for almost every performance except Smiling. Toothache was the major causal oral condition (32.7%) of almost all aspects of performance. It was concluded that this low caries people have as high an incidence of oral impacts as industrialized, high dental disease populations. Frequency and severity presented the paradoxical effect on different performances and should both be taken into account for overall estimation of impacts.

While longitudinal epidemiological studies document the rate of disease progression in populations, it is not known how people's lives are affected by oral conditions over a period of time. This study aimed to describe patterns of change in the reported impact of oral conditions among community-dwelling persons aged 61+ years in South Australia. A self-complete questionnaire, the Oral Health Impact Profile, obtained data about 49 impacts of oral conditions on everyday activities. Questionnaires were issued to 90 people once a month for 12 months and 67 people provided usable responses for at least nine months. The number of reported impacts per month formed the dependent variable for analyzing patterns of change. An increase or decrease of at least two impacts from one month to the next was categorized as a fluctuation. Year-long trends of increase or decrease in at least two impacts were identified using linear regression. Most people (86.5 per cent) experienced no trend, although nearly one half of them reported fluctuations in at least one month. Trends were more likely among denture wearers and people with 16+ missing teeth (P < 0.05), although the associations were confounded by initial impact scores which were higher for both groups. Impacts concerning eating and oral pain were subject to the greatest amount of change. The findings demonstrate that many older adults experience short-term impacts of oral conditions during longer periods of temporal stability in perceived impact of oral health.

The purpose of this study was to relate several variables (age, sex, race, number of extractions performed, dental arch, tooth position, mobility, root length, osseous resorptive defects, soft tissue inflammation, and history of preexisting pain) to the prevalence of parental report of pain in their children between forty-eight hours before (preexisting pain) and seven hours after extraction of their primary teeth (postextraction pain). Sixty-two children, ages two to ten years, were studied. The results indicated that there was no relationship between preexisting pain and the report of postextraction pain. There was a trend for females, primary molars, and presence of osseous resorptive defects to be associated with preexisting dental pain Root length (complete root formation) and presence of adjacent soft tissue inflammation were statistically significant for preexisting pain. Chronologic age was the only variable studied that was associated with postextraction pain in these children. Although the existence of pain is difficult to assess in children, the results of this study may be useful in a clinician's decision-making process as to the need for prescribed analgesics following extraction of primary teeth.

Many acute stressful experiences are not inherently very harmful, yet are associated with great pain and anxiety. The characteristics and experiences that the person brings to the situation are more important than any objective characteristics of the experience itself in determining how aversive the experience will be. Dental procedures are excellent examples of this type of stressor. Drawing primarily on the literature related to dental procedures, the present article discusses the nature of pain and anxiety in the face of an acute stressor, and presents the dispositional and situational factors that contribute to the perception of an acute stressor as aversive. A model is presented illustrating how the various factors interact. It is argued that, in addition to being descriptive, the model is also prescriptive of measures that may be taken to ameliorate the distress of persons subjected to acute stressors like dental procedures.

The importance of dental problems in comparison with general health problems and psychological problems was judged by 642 adolescents. The methods used were paired comparison and direct ranking of nine stimuli. Adolescents were quite consistent in their choices. The agreement within the group was statistically significant. Adolescents judged dental problems as less important than general health problems and as more important than psychological problems. The correlation between the methods of paired comparison and direct ranking was high. The results were compared retrospectively with findings from a study of 51 older subjects. Adolescents and adults did not differ much from each other except for the ordering of the nine problems. Adults ranked dental problems as the least important.

Chronic orofacial pain for which there is no apparent organic basis is often referred to as psychogenic pain. It is an important problem for all health professionals and has been estimated to afflict some 5 to 7 million Americans. This article reviews the nature and possible mechanisms of the various disorders associated with psychogenic pain in dental practice and methods for its management.

Previous studies have observed a substantial difference between need for dental care as determined by professional dental examiners (determined by disease presence) and that reported by potential dental patients (which may or may not be based on perceived disease presence). In this study of community-dwelling dentate older adults a substantial difference was also observed. To explore the role that factors other than disease presence may have in determining perceived current need for dental care, subjects were queried about their current oral signs, oral symptoms, psychosocial impacts from oral disease, and other factors hypothesised as affecting current need for dental care. When reporting perceived current need, subjects apparently were not responding to overall assessments of their dental health or periodontal health; rather, they were responding to specific oral signs and symptoms, and their effects. In a multivariate model, dental pain was most strongly associated with perceived need, followed by the psychosocial effects of oral diseases, reported presence of cavities, and reported presence of loose teeth. However, substantial percentages of persons reported oral signs, symptoms, and effects that would be judged professionally as sufficient for reporting a current need for dental treatment, yet did not report a need. With oral signs and symptoms accounted for, persons with less discretionary income and those who were less satisfied with their last dental visit were actually more likely to perceive a current need for dental care.(ABSTRACT TRUNCATED AT 250 WORDS)

The aims of the study were to describe the level of anxiety and pain/discomfort associated with dental treatment in two samples (N = 1288 and N = 2382) representative of an adult population, and to assess the statistical effects of these variables on utilization of dental services (dental attendance measures, expenditure, and items of dental treatment received during the last year). The prevalence of high dental anxiety in the samples as measured by Corah's Dental Anxiety Scale, the Dental Fear Scale, and the Dental Anxiety Question was 4.2%, 7.1% and 5.4%, respectively. Rather large proportions of the respondents judged dental treatment to be painful or uncomfortable: between 20 and 30% rated their last dental visit as moderately painful or worse; about 60% reported having had at least one very painful experience, and 5-6% experienced dental treatment in general to be very painful. Dental anxiety was significantly related to pain reports (correlations in the 0.32-0.48 range). There were no differences between the youngest age group (15-19 yr) and the rest of the respondents in Study II with regard to dental pain ratings. Possible explanations for these findings are discussed. The effects of dental pain and anxiety on utilization measures, although attaining significance in several of the analyses, were generally weak. Both studies demonstrated few significant differences between individuals with high dental anxiety and the rest of the study samples with respect to type and extent of dental treatment received during the last year. Thus, these data seem to show that many dentally anxious patients seek out and undergo dental treatment despite high fear levels.

Fear, anxiety and anticipation of pain are prepotent emotional and cognitive mediators of pain behaviour. As pain is often used as a parameter for evaluation of tooth vitality, existing dental anxiety may occasionally lead to possible misdiagnosis. A representative case is presented in which dental anxiety led to an initial misdiagnosis of endodontic pathology.