Introduction. Due to the considerable degree of variation that exists among care providers with respect to the assessment of patients suffering from painful temporomandibular disorders (TMDs), an interdisciplinary working group for the study of orofacial pain aimed at developing recommendations for the evaluation and diagnostic classification of such patients. Methods. Following an extensive literature search (computer-based search and handsearch), several working sessions were needed to develop a standardized diagnostic protocol.It was a prerequisite that recommended measures and instruments should have acceptable reliability and validity.Three independent reviewers-well-known experts in the pain field -critically reviewed the contents of our recommendations. Results. A two-axis approach is recommended to assess the somatic and psychosocial parameters of the pain experience.Our concept closely follows the Research Diagnostic Criteria for Temporomandibular Disorders. In addition, we distinguish a minimal, a standard, and an extended evaluation. Conclusions. The recommendations appear to be useful to enhance the diagnostic quality in the evaluation of patients with painful TMDs.
Since patients longer history revealed pain attacks of minor severity we suggest that local inflammation at the gingiva might have stimulated quiescent nociceptors over time. The local pressure to this area evoked by the new prosthesis seems to be definitive trigger factor to intensify the nociceptor response resulting in higher number of trigeminalgia attacks of marked severity. We therefore conclude that differential diagnosis of symptomatic trigeminalgia should include dental gingival mechanisms at least in a case exhibiting resistances to other treatment.
The level of total, heat stable and heat labile inhibitors of a proteolytic enzyme from Aspergillus oryzae‐protease I‐have been studied in plasma from eight patients. After treatment of these patients by infusions of 150 mg of the proteolytic enzyme in 5 % levulose solution, the change in the level of the different inhibitors have been estimated. It has been shown that there is a lowering of the total inhibitors content after each infusion. This decrease is only partly compensated for by the day following the first infusion. After the forthcoming infusions the decrease is completely compensated for resulting in a level before each subsequent infusion which is lower than that before commencement of treatment. This remaning decrease can be attributed to the heat stable inhibitor. A possible mechanism for the thrombolytic effect of the protease is mentioned.
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