Pain Update
Neurosensory testing of orofacial pain in the dental clinic

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CLINICAL PROBLEM

During an examination of a new patient, the dentist noticed that a patient turned her head away when her right cheek was touched. Touching an area of the lower lip elicited “tingling sensations,” which the patient said felt like “small insects crawling on the skin.” On inspection, the dentist did not find any visible pathology (the patient’s skin looked normal), but the dentist could provoke the sensation readily by touching a well-defined area on the lower lip. What could be the reasons for

NEUROSENSORY TESTING

QST is a psychophysical procedure in which the examiner applies test stimuli at defined intensities to a patient, who then reports his or her perceptions of the intensity and quality of the stimulus. Simple versions of QSTs have been used for centuries to learn more about the sensory systems, including how people perceive different smells and tastes, as well as auditory and somatosensory stimuli.4 We present semiquantitative chairside techniques that can be used to examine a patient’s sensory

FURTHER CONSIDERATIONS

The basic underlying mechanisms of neuropathic pain are not understood completely, but they involve a host of changes in the damaged peripheral nerve fibers (for example, upregulation of receptors), central nervous system amplifications or both. The neurobiology is complex and involves phosphorylation of nociceptors, as well as increased trafficking of intracellular signaling systems and structural changes in neurons.8 The medical management of pain and sensory disturbances related to traumatic

CONCLUSIONS

Traumatic nerve injuries are associated with distinct changes in somatosensory function. Clinicians need to know that such aberrant sensations are normal when treating patients who have neuropathic pain. Simple neurosensory testing can reveal the extent of such somatosensory changes, and the results of more sophisticated QST methods might be a way to study the mechanisms of orofacial pain.

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Disclosure. None of the authors reported any disclosures.

The research in this article was supported by National Institutes of Health grant K12-RR023247.

Pain Update is published in collaboration with the Neuroscience Group of the International Association for Dental Research.

1

Dr. Svensson is a professor and the head, Oral Physiology, Department of Dentistry, Faculty of Health, Aarhus University, Denmark; is a professor, Center for Integrative Neuroscience (CFIN), MindLab, Aarhus University Hospital, Denmark; and is a clinical consultant, Department of Oral and Maxillofacial Surgery, Aarhus University Hospital. Address reprint requests to Dr. Svensson at Aarhus University, Vennelyst Boulevard 9, DK-8000 Aarhus C, Denmark

2

Dr. Drangsholt is an associate professor and the chairman, Department of Oral Medicine, University of Washington, Seattle, and is an associate professor, Department of Dental Public Health Sciences, University of Washington, Seattle

3

Dr. Pfau is a senior scientist, Department of Neurophysiology, Center of Biomedicine and Medical Technology Mannheim, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany

4

Dr. List is a professor and the chairman, Department of Stomatognathic Physiology, Faculty of Odontology, Malmö University, Sweden

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