- Email: [email protected]
SELECTIONS FROM THE CURRENT LITERATURE
ORIGINAL CONTRIBUTIONS
JOURNALSCAN SELECTIONS FROM THE CURRENT LITERATURE Compiled by Bruce Lee Pihlstrom, DDS, MS
EVIDENCE-BASED DIAGNOSTIC CRITERIA FOR TEMPOROMANDIBULAR DISORDERS
Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. J Oral Facial Pain Headache 2014;28(1):6-27. doi:10.11607/jop.1151. Background. First published in 1992, The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were proposed as a set of criteria that could be used in the diagnosis and classification of TMDs.1 They included diagnostic criteria for the most common TMD physical diagnoses (Axis I) as well as psychosocial status and pain-related disability (Axis II). As noted by the authors of this 2014 article, the 1992 diagnostic criteria were used widely in TMD research and were a first step in improving the classification of TMDs. The purpose of this article was to present an evidence-based update of the Axis I and II diagnostic criteria for TMDs for use by both clinicians and researchers. Methods. The authors conducted a large multicenter validation study of Axis I and II TMD diagnostic criteria that was funded by the National Institutes of Health’s National Institute of Dental and Craniofacial Research. Their study involved 614 case participants who had TMDs and 91 control participants who did not have TMDs. They reported that the original RDC/TMD Axis I diagnostic criteria had poor diagnostic accuracy for the most common TMDs but that the Axis II psychosocial self-report instruments had good accuracy for screening. It was clear that the Axis I diagnostic criteria for TMD could be improved for use by researchers and clinicians. Schiffman and colleagues held several international conferences, workshops and field trials to revise, refine and finalize new evidence-based criteria for the diagnosis and classification of TMD that now can be used by both clinicians and researchers. Results. The authors presented diagnostic criteria for 12 common TMDs (arthralgia, myalgia, local myalgia, myofascial pain, myofascial pain with referral, four disc displacement disorders, degenerative joint disease, subluxation and headache attributed to TMD) in a comprehensive evidence-based classification system with codes from the International Classification of Diseases, Ninth Revision,2 and the International Classification
760
JADA 145(7)
http://jada.ada.org
of Diseases, 10th Revision.3 They also presented the diagnostic sensitivity and specificity for 10 of the 12 common TMDs, a new Axis II diagnostic protocol for the evaluation of oral parafunctional behaviors (such as oral habits), psychological status and psychosocial functioning. The assessment protocol can be used over a range of clinical applications from screening to expert evaluation. Why is this study important? This is an important article because it presents clinically based diagnostic criteria in an evidence-based TMD classification system that can be used by both clinicians and researchers to identify patients who have TMDs ranging from simple to complex. As stated by the authors, the new diagnostic criteria for temporomandibular disorders provide “a common language for all clinicians while providing the researcher with the methods for valid phenotyping of their subjects—especially for [those with] pain-related TMD.” 1. Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord 1992;6(4):301-355. 2. World Health Organization. International Classification of Diseases: Ninth Revision. Geneva: World Health Organization; 1978. 3. World Health Organization. International classification of diseases (ICD): international statistical classification of diseases and related health problems, 10th revision. http://apps.who.int/classifications/apps/icd/ icd10online2003/fr-icd.htm. Accessed June 10, 2014.
CONTROLLED CLINICAL TRIAL OF RESINBASED COMPOSITE CUSPAL RESTORATIONS
Fennis WM, Kuijs RH, Roeters FJ, Creugers NH, Kreulen CM. Randomized control trial of composite cuspal restorations: five-year results. J Dent Res 2014;93(1):36-41. doi:10.1177/0022034513510946. Background. Fractures of posterior teeth often involve tooth cusps. If a fracture is limited to the supragingival portion of the tooth, the clinician may restore the tooth by using a full crown or a direct or an indirect resin-based composite restoration. Full-crown restorations require extensive tooth preparation to ensure adequate crown retention. Direct resin-based composite restorations require minimal tooth preparation, require only a single treatment visit and have a relatively low cost. However, as noted by the authors of this study, polymerization of direct resin-based composite restorations is associated with shrinkage stress; indirect resin-based composite restorations have been used to compensate for this shrinkage and may result in better marginal adaptation of the restoration. The purpose of this randomized controlled clinical trial was to compare the performance of direct and indirect resin-based composite restorations that replaced cusps over a period of five years. Methods. Among 157 patients, Fennis and colleagues randomly assigned 176 vital premolar teeth with buccal or palatal cuspal fractures and Class II caries or restorations to be restored with either a direct or an indirect
July 2014
Copyright © 2014 American Dental Association. All Rights Reserved.
ORIGINAL CONTRIBUTIONS
resin-based composite restoration. They followed patients over a period of five years to assess rates of restoration repair (polishing after chipping of resin-based composite fragments or recementation of indirect resinbased composite restorations) and complete restoration failure (occurrence of caries, tooth fracture, or dislodged direct or recemented indirect resin-based composite restorations). Results. Fennis and colleagues reported that the fiveyear survival rates of all the resin-based composite restorations was 87 percent (95 percent confidence interval, 81 percent-93 percent). They also reported that there was no statistically significant (P < .05) difference between survival rates of direct resin-based composite restorations and those of indirect resin-based composite restorations that did not need repair (direct, 89.9 percent; indirect, 83.2 percent) or that did not fail completely (direct, 91.2 percent; indirect, 83.2 percent). Why is this study important? This is an important study because, as noted by the authors, there is a lack of long-term data regarding the use of adhesive restorations to replace missing cusps of teeth. Although the overall five-year survival rates of both types of resin-based composite restorations reported in this trial (87 percent) are somewhat less than previously reported for metalceramic crowns (94 percent),1 the results of this study suggest that both direct and indirect resin-based composite restorations are viable treatment for restoration of maxillary premolar teeth with cuspal fractures. 1. Sailer I, Pjetursson BE, Zwahlen M, Hämmerle CH. A systematic review of the survival and complication rates of all-ceramic and metalceramic reconstructions after an observation period of at least 3 years, part II: fixed dental prostheses. Clin Oral Implants Res 2007;18(3)(suppl):86-96.
EFFECT OF DIODE LASERS IN NONSURGICAL PERIODONTAL THERAPY
Slot DE, Jorritsma KH, Cobb CM, Van der Weijden GA. The effect of the thermal diode laser (wavelength 808-980 nm) in non-surgical periodontal therapy: a systematic review and meta-analysis (published online ahead of print Jan. 26, 2014). J Clin Periodontol. doi:10.1111/jcpe.12233. Background. Numerous studies have shown that improved oral hygiene, regular professional maintenance therapy and the removal of subgingival deposits of dental plaque and calculus are effective in treating periodontitis.1 Diode lasers have been used in periodontal therapy for many years as a sole treatment method and as an adjunct to the conventional therapy of scaling and root planing (SRP). As noted by the authors of this article, the reported benefits of diode laser use in periodontal therapy include enhanced removal of the periodontal pocket epithelium (subgingival curettage), reduction in subgingival bacteria, hemostasis, reduced need for local anesthesia, reduced postoperative pain and an increase
in the clinician’s ability to detect (but not remove) subgingival calculus. Researchers in many studies have investigated the effectiveness of using diode lasers as an adjunct to SRP in periodontal treatment. The authors’ purpose in this systematic review and meta-analysis was to assess the adjunctive effectiveness of using diode lasers after nonsurgical periodontal debridement. Methods. The authors used a specific search strategy and eligibility criteria to search three online databases and identify published studies in which investigators evaluated the adjunctive use of diode lasers after nonsurgical periodontal treatment. The databases included PubMed, the Cochrane Central Register of Controlled Trials and Embase. From a total of 416 articles, they identified nine studies that met predefined criteria of study design, participants, intervention and outcome. Results. Slot and colleagues reported that a metaanalysis of periodontal pocket depth, clinical attachment level and plaque scores showed no significant adjunctive effect of using a laser diode after conventional periodontal debridement. However, they found a small but statistically significant (P = .03) effect on periodontal bleeding scores (−5.34 percent; 95 percent confidence interval [CI], −10.4 percent to −0.54 percent) and on scores for a clinical measure of gingival inflammation (gingival index: mean difference = −0.09; P = .008; 95 percent CI, −.016 to −0.02). The authors questioned the clinical significance of these small effects and stated that “the results of the current review support the American Academy of Periodontology Statement on the Efficacy of Lasers in the Non-Surgical Treatment of Inflammatory Periodontal Disease that there is minimal evidence to support use of a laser for the purpose of subgingival debridement, either as a monotherapy or adjunctive to SRP.”2 Why is this study important? This is an important study because it involved a meta-analysis of data obtained from studies that were identified in a systematic search of the published literature. Within the limitations of the study, it provides dentists with an objective assessment of the use of laser diode therapy when used as an adjunct after conventional nonsurgical periodontal debridement. 1. Pihlstrom B. AAP Centennial Commentary: Theme 8. Treatment of periodontitis: key principles include removing subgingival bacterial deposits; providing a local environment and education to support good home care; providing regular professional maintenance. J Periodontol 2014;85(5):655-666. 2. American Academy of Periodontology statement on the efficacy of lasers in the non-surgical treatment of inflammatory periodontal disease. J Periodontol 2011;82(4):513-514. doi:10.1902/jop.2011.114001.
CAN DENTAL PAIN BE THE SOLE SYMPTOM OF HEART ATTACK?
Jalali N, Vilke GM, Korenevsky M, Castillo EM, Wilson MP. The tooth, the whole tooth, and nothing
JADA 145(7) Copyright © 2014 American Dental Association. All Rights Reserved.
http://jada.ada.org
July 2014
761
ORIGINAL CONTRIBUTIONS
but the tooth: can dental pain ever be the sole presenting symptom of a myocardial infarction? A systematic review (published online ahead of print Jan. 25, 2014). J Emerg Med. doi:10.1016/ j.jemermed.2013.11.071. Background. In addition to pain in the chest, shoulder or arm, pain in the jaw, teeth or face may be a symptom of an acute myocardial infarction. Moreover, according to the authors of this systematic review, it is commonly accepted that patients who experience acute cardiac ischemia may seek care solely for symptoms of jaw, tooth or facial pain. The purpose of this study was to conduct a systematic review of the published literature regarding the prevalence of jaw, tooth or facial pain as the sole presenting symptom of cardiac ischemia. Methods. Jalali and colleagues searched the PubMed database for all studies of humans in which cardiac pain was reported to originate in the jaws, teeth or face. They evaluated the main conclusions of the studies, analyzed the studies for bias and methodological errors and categorized them as being of weak, moderate or strong quality. Results. The authors identified 16 case reports involving a total of 18 patients, and two prospective cohort studies1,2 that included a total of 660 patients whose focal cardiac symptom was jaw, tooth or facial pain. Jalali and colleagues found that investigators in seven studies reported jaw, tooth or facial pain as the sole cardiac symptom, and those in the remaining studies reported that although jaw, tooth or facial pain was the primary cardiac symptom, the patients also reported having pain in the back, shoulder, clavicle, chest, arm or neck. The authors reported that the study having the highest quality (Kreiner and colleagues2) showed that six percent
762
JADA 145(7)
http://jada.ada.org
of patients with pain of cardiac origin had jaw or facial pain as their only symptom. Moreover, all but one of the patients with cardiac disease in the study by Kreiner and colleagues2 described the jaw or facial pain as “pressure” or “burning,” whereas those whose pain had an odontogenic origin usually described their pain as “throbbing” or “aching.” Overall, primarily on the basis of the prospective cohort studies of Kreiner and colleagues,1,2 Jalali and colleagues concluded that approximately six percent of patients experience craniofacial pain as the sole symptom of cardiac insufficiency. Why is this study important? This is an important study because, on the basis of their systematic review and quality assessment of published studies, the authors concluded that craniofacial pain—especially when described in terms of “burning” or “pressure”—can be the sole pain symptom of myocardial infarction. Dentists and other dental professionals need to be aware that patients with these symptoms may be having a heart attack. Q 1. Kreiner M, Okeson JP, Michelis V, Lujambio M, Isberg A. Craniofacial pain as the sole symptom of cardiac ischemia: a prospective multicenter study. JADA 2007;138(1):74-79. 2. Kreiner M, Falace D, Michelis V, Okeson JP, Isberg A. Quality difference in craniofacial pain of cardiac vs. dental origin. J Dent Res 2010;89(9):965-969. doi:10.1177/0022034510370820.
doi:10.14219/jada.2014.43 Dr. Pihlstrom is a professor emeritus, Department of Surgical and Developmental Sciences, School of Dentistry, University of Minnesota, Minneapolis. He also is the associate editor, Research, for The Journal of the American Dental Association, as well as an independent oral health research consultant. Disclosure. Dr. Pihlstrom was director of the extramural division of clinical research at the National Institutes of Health’s National Institute of Dental and Craniofacial Research (NIDCR) when one of the studies reviewed in this edition of JournalScan (Schiffman and colleagues) was funded by the NIDCR. Dr. Pihlstrom reported no other disclosures.
July 2014
Copyright © 2014 American Dental Association. All Rights Reserved.
JOURNALSCAN SELECTIONS FROM THE CURRENT LITERATURE Compiled by Bruce Lee Pihlstrom, DDS, MS
EVIDENCE-BASED DIAGNOSTIC CRITERIA FOR TEMPOROMANDIBULAR DISORDERS
Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. J Oral Facial Pain Headache 2014;28(1):6-27. doi:10.11607/jop.1151. Background. First published in 1992, The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were proposed as a set of criteria that could be used in the diagnosis and classification of TMDs.1 They included diagnostic criteria for the most common TMD physical diagnoses (Axis I) as well as psychosocial status and pain-related disability (Axis II). As noted by the authors of this 2014 article, the 1992 diagnostic criteria were used widely in TMD research and were a first step in improving the classification of TMDs. The purpose of this article was to present an evidence-based update of the Axis I and II diagnostic criteria for TMDs for use by both clinicians and researchers. Methods. The authors conducted a large multicenter validation study of Axis I and II TMD diagnostic criteria that was funded by the National Institutes of Health’s National Institute of Dental and Craniofacial Research. Their study involved 614 case participants who had TMDs and 91 control participants who did not have TMDs. They reported that the original RDC/TMD Axis I diagnostic criteria had poor diagnostic accuracy for the most common TMDs but that the Axis II psychosocial self-report instruments had good accuracy for screening. It was clear that the Axis I diagnostic criteria for TMD could be improved for use by researchers and clinicians. Schiffman and colleagues held several international conferences, workshops and field trials to revise, refine and finalize new evidence-based criteria for the diagnosis and classification of TMD that now can be used by both clinicians and researchers. Results. The authors presented diagnostic criteria for 12 common TMDs (arthralgia, myalgia, local myalgia, myofascial pain, myofascial pain with referral, four disc displacement disorders, degenerative joint disease, subluxation and headache attributed to TMD) in a comprehensive evidence-based classification system with codes from the International Classification of Diseases, Ninth Revision,2 and the International Classification
760
JADA 145(7)
http://jada.ada.org
of Diseases, 10th Revision.3 They also presented the diagnostic sensitivity and specificity for 10 of the 12 common TMDs, a new Axis II diagnostic protocol for the evaluation of oral parafunctional behaviors (such as oral habits), psychological status and psychosocial functioning. The assessment protocol can be used over a range of clinical applications from screening to expert evaluation. Why is this study important? This is an important article because it presents clinically based diagnostic criteria in an evidence-based TMD classification system that can be used by both clinicians and researchers to identify patients who have TMDs ranging from simple to complex. As stated by the authors, the new diagnostic criteria for temporomandibular disorders provide “a common language for all clinicians while providing the researcher with the methods for valid phenotyping of their subjects—especially for [those with] pain-related TMD.” 1. Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord 1992;6(4):301-355. 2. World Health Organization. International Classification of Diseases: Ninth Revision. Geneva: World Health Organization; 1978. 3. World Health Organization. International classification of diseases (ICD): international statistical classification of diseases and related health problems, 10th revision. http://apps.who.int/classifications/apps/icd/ icd10online2003/fr-icd.htm. Accessed June 10, 2014.
CONTROLLED CLINICAL TRIAL OF RESINBASED COMPOSITE CUSPAL RESTORATIONS
Fennis WM, Kuijs RH, Roeters FJ, Creugers NH, Kreulen CM. Randomized control trial of composite cuspal restorations: five-year results. J Dent Res 2014;93(1):36-41. doi:10.1177/0022034513510946. Background. Fractures of posterior teeth often involve tooth cusps. If a fracture is limited to the supragingival portion of the tooth, the clinician may restore the tooth by using a full crown or a direct or an indirect resin-based composite restoration. Full-crown restorations require extensive tooth preparation to ensure adequate crown retention. Direct resin-based composite restorations require minimal tooth preparation, require only a single treatment visit and have a relatively low cost. However, as noted by the authors of this study, polymerization of direct resin-based composite restorations is associated with shrinkage stress; indirect resin-based composite restorations have been used to compensate for this shrinkage and may result in better marginal adaptation of the restoration. The purpose of this randomized controlled clinical trial was to compare the performance of direct and indirect resin-based composite restorations that replaced cusps over a period of five years. Methods. Among 157 patients, Fennis and colleagues randomly assigned 176 vital premolar teeth with buccal or palatal cuspal fractures and Class II caries or restorations to be restored with either a direct or an indirect
July 2014
Copyright © 2014 American Dental Association. All Rights Reserved.
ORIGINAL CONTRIBUTIONS
resin-based composite restoration. They followed patients over a period of five years to assess rates of restoration repair (polishing after chipping of resin-based composite fragments or recementation of indirect resinbased composite restorations) and complete restoration failure (occurrence of caries, tooth fracture, or dislodged direct or recemented indirect resin-based composite restorations). Results. Fennis and colleagues reported that the fiveyear survival rates of all the resin-based composite restorations was 87 percent (95 percent confidence interval, 81 percent-93 percent). They also reported that there was no statistically significant (P < .05) difference between survival rates of direct resin-based composite restorations and those of indirect resin-based composite restorations that did not need repair (direct, 89.9 percent; indirect, 83.2 percent) or that did not fail completely (direct, 91.2 percent; indirect, 83.2 percent). Why is this study important? This is an important study because, as noted by the authors, there is a lack of long-term data regarding the use of adhesive restorations to replace missing cusps of teeth. Although the overall five-year survival rates of both types of resin-based composite restorations reported in this trial (87 percent) are somewhat less than previously reported for metalceramic crowns (94 percent),1 the results of this study suggest that both direct and indirect resin-based composite restorations are viable treatment for restoration of maxillary premolar teeth with cuspal fractures. 1. Sailer I, Pjetursson BE, Zwahlen M, Hämmerle CH. A systematic review of the survival and complication rates of all-ceramic and metalceramic reconstructions after an observation period of at least 3 years, part II: fixed dental prostheses. Clin Oral Implants Res 2007;18(3)(suppl):86-96.
EFFECT OF DIODE LASERS IN NONSURGICAL PERIODONTAL THERAPY
Slot DE, Jorritsma KH, Cobb CM, Van der Weijden GA. The effect of the thermal diode laser (wavelength 808-980 nm) in non-surgical periodontal therapy: a systematic review and meta-analysis (published online ahead of print Jan. 26, 2014). J Clin Periodontol. doi:10.1111/jcpe.12233. Background. Numerous studies have shown that improved oral hygiene, regular professional maintenance therapy and the removal of subgingival deposits of dental plaque and calculus are effective in treating periodontitis.1 Diode lasers have been used in periodontal therapy for many years as a sole treatment method and as an adjunct to the conventional therapy of scaling and root planing (SRP). As noted by the authors of this article, the reported benefits of diode laser use in periodontal therapy include enhanced removal of the periodontal pocket epithelium (subgingival curettage), reduction in subgingival bacteria, hemostasis, reduced need for local anesthesia, reduced postoperative pain and an increase
in the clinician’s ability to detect (but not remove) subgingival calculus. Researchers in many studies have investigated the effectiveness of using diode lasers as an adjunct to SRP in periodontal treatment. The authors’ purpose in this systematic review and meta-analysis was to assess the adjunctive effectiveness of using diode lasers after nonsurgical periodontal debridement. Methods. The authors used a specific search strategy and eligibility criteria to search three online databases and identify published studies in which investigators evaluated the adjunctive use of diode lasers after nonsurgical periodontal treatment. The databases included PubMed, the Cochrane Central Register of Controlled Trials and Embase. From a total of 416 articles, they identified nine studies that met predefined criteria of study design, participants, intervention and outcome. Results. Slot and colleagues reported that a metaanalysis of periodontal pocket depth, clinical attachment level and plaque scores showed no significant adjunctive effect of using a laser diode after conventional periodontal debridement. However, they found a small but statistically significant (P = .03) effect on periodontal bleeding scores (−5.34 percent; 95 percent confidence interval [CI], −10.4 percent to −0.54 percent) and on scores for a clinical measure of gingival inflammation (gingival index: mean difference = −0.09; P = .008; 95 percent CI, −.016 to −0.02). The authors questioned the clinical significance of these small effects and stated that “the results of the current review support the American Academy of Periodontology Statement on the Efficacy of Lasers in the Non-Surgical Treatment of Inflammatory Periodontal Disease that there is minimal evidence to support use of a laser for the purpose of subgingival debridement, either as a monotherapy or adjunctive to SRP.”2 Why is this study important? This is an important study because it involved a meta-analysis of data obtained from studies that were identified in a systematic search of the published literature. Within the limitations of the study, it provides dentists with an objective assessment of the use of laser diode therapy when used as an adjunct after conventional nonsurgical periodontal debridement. 1. Pihlstrom B. AAP Centennial Commentary: Theme 8. Treatment of periodontitis: key principles include removing subgingival bacterial deposits; providing a local environment and education to support good home care; providing regular professional maintenance. J Periodontol 2014;85(5):655-666. 2. American Academy of Periodontology statement on the efficacy of lasers in the non-surgical treatment of inflammatory periodontal disease. J Periodontol 2011;82(4):513-514. doi:10.1902/jop.2011.114001.
CAN DENTAL PAIN BE THE SOLE SYMPTOM OF HEART ATTACK?
Jalali N, Vilke GM, Korenevsky M, Castillo EM, Wilson MP. The tooth, the whole tooth, and nothing
JADA 145(7) Copyright © 2014 American Dental Association. All Rights Reserved.
http://jada.ada.org
July 2014
761
ORIGINAL CONTRIBUTIONS
but the tooth: can dental pain ever be the sole presenting symptom of a myocardial infarction? A systematic review (published online ahead of print Jan. 25, 2014). J Emerg Med. doi:10.1016/ j.jemermed.2013.11.071. Background. In addition to pain in the chest, shoulder or arm, pain in the jaw, teeth or face may be a symptom of an acute myocardial infarction. Moreover, according to the authors of this systematic review, it is commonly accepted that patients who experience acute cardiac ischemia may seek care solely for symptoms of jaw, tooth or facial pain. The purpose of this study was to conduct a systematic review of the published literature regarding the prevalence of jaw, tooth or facial pain as the sole presenting symptom of cardiac ischemia. Methods. Jalali and colleagues searched the PubMed database for all studies of humans in which cardiac pain was reported to originate in the jaws, teeth or face. They evaluated the main conclusions of the studies, analyzed the studies for bias and methodological errors and categorized them as being of weak, moderate or strong quality. Results. The authors identified 16 case reports involving a total of 18 patients, and two prospective cohort studies1,2 that included a total of 660 patients whose focal cardiac symptom was jaw, tooth or facial pain. Jalali and colleagues found that investigators in seven studies reported jaw, tooth or facial pain as the sole cardiac symptom, and those in the remaining studies reported that although jaw, tooth or facial pain was the primary cardiac symptom, the patients also reported having pain in the back, shoulder, clavicle, chest, arm or neck. The authors reported that the study having the highest quality (Kreiner and colleagues2) showed that six percent
762
JADA 145(7)
http://jada.ada.org
of patients with pain of cardiac origin had jaw or facial pain as their only symptom. Moreover, all but one of the patients with cardiac disease in the study by Kreiner and colleagues2 described the jaw or facial pain as “pressure” or “burning,” whereas those whose pain had an odontogenic origin usually described their pain as “throbbing” or “aching.” Overall, primarily on the basis of the prospective cohort studies of Kreiner and colleagues,1,2 Jalali and colleagues concluded that approximately six percent of patients experience craniofacial pain as the sole symptom of cardiac insufficiency. Why is this study important? This is an important study because, on the basis of their systematic review and quality assessment of published studies, the authors concluded that craniofacial pain—especially when described in terms of “burning” or “pressure”—can be the sole pain symptom of myocardial infarction. Dentists and other dental professionals need to be aware that patients with these symptoms may be having a heart attack. Q 1. Kreiner M, Okeson JP, Michelis V, Lujambio M, Isberg A. Craniofacial pain as the sole symptom of cardiac ischemia: a prospective multicenter study. JADA 2007;138(1):74-79. 2. Kreiner M, Falace D, Michelis V, Okeson JP, Isberg A. Quality difference in craniofacial pain of cardiac vs. dental origin. J Dent Res 2010;89(9):965-969. doi:10.1177/0022034510370820.
doi:10.14219/jada.2014.43 Dr. Pihlstrom is a professor emeritus, Department of Surgical and Developmental Sciences, School of Dentistry, University of Minnesota, Minneapolis. He also is the associate editor, Research, for The Journal of the American Dental Association, as well as an independent oral health research consultant. Disclosure. Dr. Pihlstrom was director of the extramural division of clinical research at the National Institutes of Health’s National Institute of Dental and Craniofacial Research (NIDCR) when one of the studies reviewed in this edition of JournalScan (Schiffman and colleagues) was funded by the NIDCR. Dr. Pihlstrom reported no other disclosures.
July 2014
Copyright © 2014 American Dental Association. All Rights Reserved.