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Dental and facial pain: introduction
VO LU M E 51 • NUMBER 4
OCTO BER 1955
W
'/•///• A \ / Z /Ï/ ( 1 / V O M F A t A S S O C / I7 Z 0 / V
D e n ta l a n d fa c ia l p a in : in tr o d u c tio n
L. Laszlo Schwartz, D.D.S., New York
“ Pain is the most individualizing thing on earth,” writes Edith Hamilton in her Great Age of Greek Literature. “ It is true,” she continues, “ that it is the great common bond as well, but that realization comes when it is over. T o suffer is to be alone; to watch another suffer is to know the barrier that shuts each of us away by himself. Only individuals can suffer.” The truth of this observation can be appreciated particularly by dentists who as a profession face the problem of pain daily. In addition to their routine tasks, however, dentists are often called on to cope with problems of pain for which the cause is obscure and management difficult. Pain for which the patient cannot find an explanation is especially alarming. Since he is almost as familiar with dental pain as he is with the pain of childhood cuts and bruises, the patient suffering from any painful symptoms of the jaws or face often goes first to see his dentist. The reason for this is not entirely based on his familiarity with dental pain. Ambroise Paré, seventeenth century French surgeon, the father of surgery, de scribed toothache as the most atrocious pain that can torment a man without being followed by death.1 Thus, the patient seeks his dentist in the hope that his pain may prove to be dental. This knowledge provides him with reassurance and the expectation of prompt relief. Dental pain, common though it is, presents problems in diagnosis and treatment which often tax the judgment and skill of the practitioner. In addition, if no dental I. Oevres completes d'Am broise Paré, accom pagneés de notes historiques et critiques, par J . Paris, 1840, vol. ii, p. 443. 393
F. M elgaigne,
374 • T H E JO U R N A L O F T H E A M E R IC A N DENTAL A S S O C IA T IO N
cause is found, the dentist must be equipped with a knowledge of fields other than his own in order to make full use, through consultation, of the abilities of medical specialists. The fact that he is the first to see the patient places special responsibilities on him. The symposium, herewith presented, on the diagnosis and control of dental and facial pain grew out of the combined efforts in research, teaching) and practice of dentists and physicians at the Columbia-Presbyterian Medical Center. The sympo sium was presented on October 12, 1953, as one of nine concurrent symposia covering various aspects of dentistry, medicine, surgery and nursing held during the twentyfifth anniversary celebration of the Medical Center. It is hoped that publication will serve not only to emphasize the difficulties pre sented by the complexities of dental and facial pain, but also will point to the benefits which both dentists and physicians, and consequently patients, may derive through closer working relationships.
P a in a s s o c ia t e d w it h th e te m p o r o m a n d ib u la r jo in t
L. Laszlo Schwartz, D.D.S., New York
Temporomandibular joint pain is a symptom which is often alarming to the patient and perplexing to the practi tioner. Many papers have been pub lished, yet the cause of this symptom is still controversial and its treatment is varied and undependable. Pain was but one of the symptoms included in the syndrome described by Costen which now bears his name.1 This syndrome includes symptoms as varied as impaired hearing, vertigo, tinnitus, and temporomandibular joint pain. Costen maintained that this symptom complex was caused by the closing of the bite which permitted posterior displace ment o f the condyle. He held that pain arose as a result of irritation of the chorda tympani and pressure on or near the auriculotemporal nerve. Bite raising was the treatment recommended, and it was practiced extensively.
Different aspects of the syndrome have been questioned. In a recent evaluation, Zimmermann concludes that: It is evident that from an anatomic and func tional point of view there is only one group of symptoms in Costen’s syndrome of man dibular overclosure that has a basis of accept able facts: trigeminal and occipital neuralgias. All other symptoms are highly questionable. The syndrome as such should be abandoned.2
During the past five years, the exam ination of over 500 patients in the Tem poromandibular Joint Clinic, a research
C linical professor of dentistry; head, division of clinical oral physiology, School of Dental and O ral Surgery, Faculty of M edicine, Colum bia University; dental service, Presbyterian H ospital. 1. Costen, J . B. A syndrome of ear and sinus symp toms dependent upon disturbed function of the tem porom andibular joint. Ann. Otol., Rhin. & Laryn. 43:1 March 1934. 2. Sarnat, B. G ., editor. The tem porom andibular ioint. Springfield, Charles C Thomas, 1951, p. 107.
OCTO BER 1955
W
'/•///• A \ / Z /Ï/ ( 1 / V O M F A t A S S O C / I7 Z 0 / V
D e n ta l a n d fa c ia l p a in : in tr o d u c tio n
L. Laszlo Schwartz, D.D.S., New York
“ Pain is the most individualizing thing on earth,” writes Edith Hamilton in her Great Age of Greek Literature. “ It is true,” she continues, “ that it is the great common bond as well, but that realization comes when it is over. T o suffer is to be alone; to watch another suffer is to know the barrier that shuts each of us away by himself. Only individuals can suffer.” The truth of this observation can be appreciated particularly by dentists who as a profession face the problem of pain daily. In addition to their routine tasks, however, dentists are often called on to cope with problems of pain for which the cause is obscure and management difficult. Pain for which the patient cannot find an explanation is especially alarming. Since he is almost as familiar with dental pain as he is with the pain of childhood cuts and bruises, the patient suffering from any painful symptoms of the jaws or face often goes first to see his dentist. The reason for this is not entirely based on his familiarity with dental pain. Ambroise Paré, seventeenth century French surgeon, the father of surgery, de scribed toothache as the most atrocious pain that can torment a man without being followed by death.1 Thus, the patient seeks his dentist in the hope that his pain may prove to be dental. This knowledge provides him with reassurance and the expectation of prompt relief. Dental pain, common though it is, presents problems in diagnosis and treatment which often tax the judgment and skill of the practitioner. In addition, if no dental I. Oevres completes d'Am broise Paré, accom pagneés de notes historiques et critiques, par J . Paris, 1840, vol. ii, p. 443. 393
F. M elgaigne,
374 • T H E JO U R N A L O F T H E A M E R IC A N DENTAL A S S O C IA T IO N
cause is found, the dentist must be equipped with a knowledge of fields other than his own in order to make full use, through consultation, of the abilities of medical specialists. The fact that he is the first to see the patient places special responsibilities on him. The symposium, herewith presented, on the diagnosis and control of dental and facial pain grew out of the combined efforts in research, teaching) and practice of dentists and physicians at the Columbia-Presbyterian Medical Center. The sympo sium was presented on October 12, 1953, as one of nine concurrent symposia covering various aspects of dentistry, medicine, surgery and nursing held during the twentyfifth anniversary celebration of the Medical Center. It is hoped that publication will serve not only to emphasize the difficulties pre sented by the complexities of dental and facial pain, but also will point to the benefits which both dentists and physicians, and consequently patients, may derive through closer working relationships.
P a in a s s o c ia t e d w it h th e te m p o r o m a n d ib u la r jo in t
L. Laszlo Schwartz, D.D.S., New York
Temporomandibular joint pain is a symptom which is often alarming to the patient and perplexing to the practi tioner. Many papers have been pub lished, yet the cause of this symptom is still controversial and its treatment is varied and undependable. Pain was but one of the symptoms included in the syndrome described by Costen which now bears his name.1 This syndrome includes symptoms as varied as impaired hearing, vertigo, tinnitus, and temporomandibular joint pain. Costen maintained that this symptom complex was caused by the closing of the bite which permitted posterior displace ment o f the condyle. He held that pain arose as a result of irritation of the chorda tympani and pressure on or near the auriculotemporal nerve. Bite raising was the treatment recommended, and it was practiced extensively.
Different aspects of the syndrome have been questioned. In a recent evaluation, Zimmermann concludes that: It is evident that from an anatomic and func tional point of view there is only one group of symptoms in Costen’s syndrome of man dibular overclosure that has a basis of accept able facts: trigeminal and occipital neuralgias. All other symptoms are highly questionable. The syndrome as such should be abandoned.2
During the past five years, the exam ination of over 500 patients in the Tem poromandibular Joint Clinic, a research
C linical professor of dentistry; head, division of clinical oral physiology, School of Dental and O ral Surgery, Faculty of M edicine, Colum bia University; dental service, Presbyterian H ospital. 1. Costen, J . B. A syndrome of ear and sinus symp toms dependent upon disturbed function of the tem porom andibular joint. Ann. Otol., Rhin. & Laryn. 43:1 March 1934. 2. Sarnat, B. G ., editor. The tem porom andibular ioint. Springfield, Charles C Thomas, 1951, p. 107.