Substantiation of application of pneumoexercise machine mouth gag in patients with chewing muscle hypertonus

The hypertone of chewing muscles is the leading reason of development of pain of non-odontogenic character in maxillofacial area. This pathology is rather widespread, at the same time has permanent character and is characterized average or heavy degree of expressiveness of clinical symptoms. Muscular pains considerably reduce working capacity and worsen quality of life of patients. Treatment of a hypertone of chewing muscles is relevant in stomatology. For clear understanding of genesis of development of muscular frustration in work the anatomy of a temporal and mandibular joint and chewing muscles is in detail presented systems. Modern methods of treatment of a hyper tone of chewing muscles include correction of occlusion that doesn’t eliminate a painful symptom; orthopedic and orthodontic treatment with application a cap. However, application of above-mentioned methods is rather effective, there is no exact understanding of the mechanism of their action. At some patients the temporary improvement of a state is noted, – gets the chronic sluggish long course of development of a disease which doesn’t give in by any known methods subsequently from others. Dentists perfectly understand this fact, at the same time the disappointment from the treatment comes in spite of the fact that all efforts were bent on improvement of knowledge in the field of factors predictors of development of pathology, modern methods of diagnostics and treatment of muscular frustration. In this work the use of the pneumoexercise machine mouth gag as the device relaxing muscles and separating device on the one hand, and possibilities of his use as a stimulator of process of the return development of the available already structural and functional changes of muscle tissue with another is proved. Accurate indications and contraindications to use of this device are submitted. It is recommended to use the device as the low-invasive method which isn’t leading to irreversible consequences. Further need of development of practical recommendations on uses of the pneumoexercise machine mouth gag as is obvious to patients and their parents, and to dentists in the medical and preventive purposes.

The role of electrotherapy in reducing the pain of patients with knee osteoarthritis during the COVID-19 pandemic

Introduction. Osteoarthritis is considered to be the most common form of arthritis and a leading disability cause worldwide, especially due to the painful symptom. The latter is a clinical marker in evaluating the limits of joint mobility and therefore, the pain reduction is a goal of the recovery treatment for patients with knee osteoarthritis. The purpose of this study was to show whether the pain phenomenon characteristic of knee osteoarthritis can be reduced by electrotherapy, even in the context of the COVID-19 pandemic. Material and method. The study lasted 5 months and included 171 patients diagnosed clinically and radiologically with knee osteoarthritis. The followed parameters were pain, physical dysfunction in daily activities, anxiety and quality of life. Results and discussions. The two groups of studied patients were homogeneous in terms of weight by gender and age groups. The evaluation of patients according to scales enabled the registration of statistically significant values, the value of p <0.05, which explains the validation of the working hypothesis. The feeling of pain is closely related to the level of anxiety. Conclusions. Analgesic electrotherapy significantly reduced the pain syndrome of the patients for whom it was used. It has been shown that the patients' anxiety can influence the pain phenomenon. Given the conditions caused by the Covid-19 pandemic, the anxiety of the patients who were in the outpatient department to receive recovery treatment was increased, but after the recovery treatment there was a decrease, so these patients' quality of life increased. Keywords: pain, analgesic electrotherapy, knee osteoarthritis, recovery treatment,

Transabdominal ultrasonography: A non-invasive method for diagnosing vaginal atrophy

Objective Genitourinary syndrome of menopause is a definition of all symptoms caused by hypoestrogenemia in menopausal age and one of the most common symptoms is vaginal atrophy. The diagnosis methods which are used for vaginal atrophy may be painful. A novel method total vaginal thickness and total mucosal thickness measuring could be determine vaginal atrophy. Material and methods This is a prospective case–control study involving 60 women in each group of 120 patients. One of the groups is comprised postmenopausal, histopathologically diagnosed vaginal atrophic women and the other group comprised 24–35 aged women who were no symptoms of vaginal atrophy and vaginal swab samples are not compatible with vaginal atrophy. All women who participated in the study underwent transabdominal ultrasound and total vaginal thickness and total mucosal thickness were measured. Results Total vaginal thickness and total mucosal thickness were found lower in the postmenopausal group compared to premenopausal women ( p = 0.005 and p = 0.07, respectively). The cutoff value was determined as 8.55 mm for total vaginal thickness and 1.52 mm for total mucosal thickness, and the diagnostic power of these values is a specificity of 88.89% (95% confidence interval: 51.75–99.72%) and a ppv of 92.86% (95% confidence interval: 66.53–98.84%) for total vaginal thickness and a specificity of 80.95% (95% confidence interval: 58.09–94.55%) and a ppv of 89.47% (95% confidence interval: 71.10–96.71%) for total mucosal thickness. Conclusion Vaginal atrophy is a painful symptom for menopausal women and the diagnostic methods may be invasive and painful too. Total vaginal thickness and total mucosal thickness measuring with transabdominal ultrasound could be an alternative method for diagnosis and treat vaginal atrophy easily.

Female Sexual Function in Women with Suspected Deep Infiltrating Endometriosis

Objective To evaluate the quality of the sexual function of women with suspected deep infiltrating endometriosis. Methods A cross-sectional, observational and prospective study was conducted between May 2015 and August 2016, in which 67 patients with deep infiltrating endometriosis, suspected or diagnosed, were assessed for epidemiological and clinical characteristics, such as pain level through a visual analog scale (VAS), features of deep infiltrating endometriosis lesions and score on the Female Sexual Function Index (FSFI) before the onset of treatment. The statistical analysis was performed using the software STATA version 12.0 (StataCorp LLC, College Station, TX, USA) to compare the variables through multiple regression analysis. Results The average age of the patients was 39.2 years old; most patients were symptomatic (92.5%); and the predominant location of the deep infiltrating lesions was on the rectosigmoid colon (50%), closely followed by the retrocervical region (48.3%). The median overall score on the FSFI was 23.4; in 67.2% of the cases the score was ≤ 26.5 (cutoff point for sexual dysfunction). Deep dyspareunia (p = 0.000, confidence interval [CI]: 0.64–0.83) and rectosigmoid endometriosis lesions (p = 0.008, CI: 0.72–0.95) showed significant correlation with lower FSFI scores, adjusted by bladder lesion, patients' age and size of lesions. Deep dyspareunia (p = 0.003, CI: 0.49–0.86) also exhibited significant correlation with FSFI pain domain, adjusted by cyclic bowel pain, vaginal lesion and use of gonadotropin-releasing hormone (GnRH) analog. These results reflect the influence of deep dyspareunia on the sexual dysfunction of the analyzed population. Conclusion Most patients exhibited sexual dysfunction, and deep dyspareunia was the pelvic painful symptom that showed correlation with sexual dysfunction.

Evidence of Signs and Symptoms of Craniomandibular Disorders in Fibromyalgia Patients

Objective: The purpose of this study is to highlight the evidence of signs and symptoms of craniomandibular disorders (CMD) in patients suffering from fibromyalgia. Materials and Method: The study has been carried out from May 2011 to May 2015, recruiting a sample of fibromyalgia patients at the Department of Neurophysiopathology at the hospital Policlinico in Bari. Among the 150 examined patients, 60 of them have been diagnosed to suffer from fibromyalgia and 27 accepted to be investigated with a gnathologic examination at the Dental School at the University of Bari. Results: 24 patients (88.9%) were women and 3 (11.1%) men; from 26 to 66 years old (average age, 39). 14 patients (51.9%) were affected by primary fibromyalgia, the remaining 13 (48.1%) by secondary fibromyalgia, mainly associated with hypothyroidism (29.6%). VAS average score was about 8 ± 1.85. The frequency of pain was daily in 15 patients (55.6%); twice a week in 10 patients (37.03%) and a few times a month in 2 patients (7.4%). 11 patients (40.7%) attributed the onset of fibromyalgia to a specific instigating event. In addition, from the gnathologic anamnesis, 11 patients (40,7%) reported a painful symptom in the head-neck region, especially in the frontal region, in the neck, in the masseter muscle and ATM. VAS average score was 3.4 ± 2.8, significantly lower than the one referring to the fibromyalgia pain. The gnathological examination found CMD signs and symptoms in 18 patients (66.7%). Concerning the prevalence of CMD, in type I fibromyalgia, myofascial pain was more frequent (5 patients), whereas in type II fibromyalgia, what was more frequent was a dislocation with reduction (3 patients). Conclusion: Based on clinic experience, we can affirm that some patients with CMD report pain in other regions. It is difficult to distinguish the CMD forms directly correlated to fibromyalgia from those engendered by parafunctional activities; hence the need is to resolve the fibromyalgia syndrome adopting a multidisciplinary approach.

Clinical Phenotype of Diabetic Peripheral Neuropathy and Relation to Symptom Patterns: Cluster and Factor Analysis in Patients with Type 2 Diabetes in Korea

Objectives. Patients with diabetic peripheral neuropathy (DPN) is the most common complication. However, patients are usually suffering from not only diverse sensory deficit but also neuropathy-related discomforts. The aim of this study is to identify distinct groups of patients with DPN with respect to its clinical impacts on symptom patterns and comorbidities. Methods. A hierarchical cluster analysis and factor analysis were performed to identify relevant subgroups of patients with DPN (n=1338) and symptom patterns. Results. Patients with DPN were divided into three clusters: asymptomatic (cluster 1, n=448, 33.5%), moderate symptoms with disturbed sleep (cluster 2, n=562, 42.0%), and severe symptoms with decreased quality of life (cluster 3, n=328, 24.5%). Patients in cluster 3, compared with clusters 1 and 2, were characterized by higher levels of HbA1c and more severe pain and physical impairments. Patients in cluster 2 had moderate pain levels but disturbed sleep patterns comparable to those in cluster 3. The frequency of symptoms on each item of MNSI by “painful” symptom pattern showed a similar distribution pattern with increasing intensities along the three clusters. Conclusions. Cluster and factor analysis endorsed the use of comprehensive and symptomatic subgrouping to individualize the evaluation of patients with DPN.

Orofacial Pain: Patient Satisfaction and Delay of Urgent Care

Objective. Accomplishing the Healthy People 2010 goal of eliminating disparities in oral disease will require a better understanding of the patterns of health care associated with orofacial pain. This study examined factors associated with pain-related acute oral health care. Methods. The authors used data on 698 participants in the Florida Dental Care Study, a study of oral health among dentate adults aged 45 years and older at baseline. Results. Fifteen percent of the respondents reported having had at least one dental visit as the result of orofacial pain. The majority of the respondents reportedly delayed contacting a dentist for at least one day; however, there was no difference between respondents reporting pain as the initiating symptom and those with other problems. Once respondents decided that dental services were needed, those with a painful symptom were nearly twice as likely as those without pain to want to be seen immediately. Rural adults were more likely than urban adults to report having received urgent dental care for a painful symptom. When orofacial pain occurred, those who identified as non-Hispanic African American were more likely than those who identified as non-Hispanic white to delay care rather than to seek treatment immediately, and women were more likely then men. Having a pain-related oral problem was associated with significantly less satisfaction with the services provided; non-Hispanic African American respondents were less likely than non-Hispanic white respondents to report being very satisfied, and rural residents were less likely than urban residents. Furthermore, men were more likely than women to suffer with orofacial pain without receiving either scheduled dental care or an urgent visit. Conclusions. Barriers to care are complex and likely to be interactive, but must be understood before the goals of Healthy People 2010 can be accomplished.