Okeson Bell's Oral and Facial Pain (Formerly Bell's Orofacial Pain)

Seventh Edition
7. Auflage 2020
ISBN: 978-0-86715-671-3
Verlag: Quintessence Publishing Co, Inc
Format: EPUB
Kopierschutz: Adobe DRM (»Systemvoraussetzungen)

E-Book, Englisch, Band 7, 560 Seiten

Reihe: Edition

Pain, especially chronic pain, is a major health care problem, a fact that has precipitated a recent dramatic expansion in pain-related research efforts. This revised edition of Dr Welden Bell's classic text has been updated to incorporate the latest findings from these studies, including advanced understanding of the neurophysiology and central processing of pain and the resulting changes to diagnostic, classification, and treatment guidelines. To assist clinicians in the difficult and often complicated task of managing patients suffering from oral and facial pain, this textbook provides documented information concerning pain and pain behavior so that one may better understand what pain is, how it behaves, and how it might best be managed; develops a useful classification of orofacial pain disorders; offers practical diagnostic criteria by which the different orofacial pain disorders can be identified on a clinical level; and suggests guidelines for the effective management of patients who suffer from pain in the region of the mouth and face. The concepts and techniques discussed are supplemented with case reports as well as new, full-color photographs and illustrations to help the clinician better understand orofacial pain disorders and how to treat them effectively.

Dr. Jeffrey P Okeson has dedicated his career to educating students, residents and clinicians in the areas of occlusion, temporomandibular disorders and orofacial pain. He has been a full time faculty member at the University of Kentucky for 45 years. He is recognized worldwide as an authority in the field of TMD and orofacial pain, lecturing in every state in the USA and 58 different foreign countries. His textbooks have been translated into eleven different foreign languages and have become a standard for teaching throughout the world. His peers have called him the 'World Ambassador for Orofacial pain'. He is a highly sought after speaker and has given more than 1300 invited lectures throughout the world. He has received numerous awards, honors and recognitions for his outstanding teaching and educational abilities. Some of these awards include the campus wide University of Kentucky 'Great Teacher Award', the Provost's Distinguished Service Professorship, the American Academy of Orofacial Pain's Service Award and the first ever 'Distinguished Alumni Award' from the College of Dentistry. In addition, he received the State of Kentucky Acorn Award for the best professor in the state and was inducted into the University of Kentucky Hall of Distinguished Alumni. Dr. Okeson has also received 'The International Dentist of the Year Award' from the Academy of Dentistry International. This is the highest award recognized by this Academy and was given to him in recognition of his worldwide efforts in providing education in the area of temporomandibular disorders and orofacial pain. In addition to his two textbooks, he has more then 240 publications in scientific journals. He is director of the Orofacial Pain Center at the University of Kentucky which he founded in 1977.  He has developed several full-time teaching programs associated with the Center. The Master of Science Degree program he established was the first in the United States to be accredited by the American Academy of Orofacial Pain. The Orofacial Pain Residency Program was one of the very first to be accredited by the Commission on Dental Accreditation. This program has graduated 60 full time residents from 26 different countries. He is active in many national and international organizations and is past president of the American Academy of Orofacial Pain. He is also a founding diplomate and twice past president of the American Board of Orofacial Pain. Dr. Okeson is a captivating lecturer with a teaching style that is engaging, logical and based on the available science. He is one of the few individuals in the world capable of bringing all these subjects together into one lecture series.

Autoren/Hrsg.

Okeson, Jeffrey P.

Leseproben

Pain is an unpleasant sensory and emotional experience that motivates the individual far more than perhaps any other life experience. Pain significantly impairs the lives of millions of people around the world, and the clinical management of pain is a primary concern of health professionals. It is interesting to note that the profession has become extremely effective in the management of acute pain secondary to surgical procedures. The same, however, cannot be said about the control of pain that becomes persistent or chronic. There are good reasons for this. The cause of surgical pain is obvious and expected. It is associated with tissue injury, and it is routinely managed by either suppressing the passage of nociceptive impulses or making the patient insensible to them. Therefore, an effective solution lies within the grasp of the clinician. Chronic pain, however, often presents with different circumstances. Although the classic definition of chronic pain is pain that lasts longer then 6 months, the more functional definition is pain that lasts longer than the normal healing time. One would expect pain during healing; however, when pain continues beyond the healing process, other mechanisms need to be considered. Often with chronic pain the patient reports the pain in structures that appear normal, making diagnosis and management much more difficult. The mechanisms that are involved with chronic pain are different than those associated with surgical pain. As a rule, orofacial pain from an obvious cause, such as a toothache, is managed with no difficulty at all. But when a pain occurs spontaneously or without evidence of structural cause, the clinician may become confused and frustrated. In order for the clinician to effectively manage chronic pain, he or she must have a basic understanding of the mechanisms that create this unpleasant experience. These mechanisms are certainly not easy to understand because our knowledge base falls short of being complete. The purpose of this text is to present the latest information regarding our understanding of pain. The explosion of information in the area of pain is so great that keeping a text updated is an extremely difficult task. It is the author’s hope that the information provided in this text will assist the clinician in managing orofacial pain disorders. However, the reader also needs to keep up with current research findings that may shed new light on this most complex problem. As a clinical symptom, pain is an experience that cannot be shared. It is wholly personal, belonging to the sufferer alone. Different individuals sensing identical noxious stimulation feel pain in different ways and react at different levels of suffering. It is impossible for one person to sense exactly what another feels. Therefore, clinicians are faced with the task of obtaining from a patient enough information to help them imagine how that individual experiences and interprets the meaning of the pain. The ability to diagnose and treat a person afflicted with pain rests largely on knowledge of the mechanisms and behavioral characteristics of pain in its various manifestations. The specific goals of this textbook are: (1) to supply sufficient documented information concerning pain and pain behavior so that one may better understand what pain is, how it behaves, and how it might best be managed; (2) to develop a useful classification of orofacial pain disorders; (3) to offer practical diagnostic criteria by which the different orofacial pain disorders can be identified on a clinical level; and (4) to suggest guidelines for the effective management of patients who suffer pain in the region of the mouth and face. In recent years, the amount of information on pain has dramatically increased, and our research knowledge is expanding exponentially. It is very difficult to keep abreast of all the new findings. For every question that is answered, ten more questions arise. Although we are more knowledgeable today than ever before, we are still only touching the surface of all there is to know about pain. This textbook cannot delve into every aspect of pain. Rather, it is intended to provide the clinician with information that will assist in managing patients suffering from orofacial pain. For readers who would like a more detailed description of the basic science of pain physiology, other texts should be pursued. Pain as a Clinical Problem Pain, especially chronic pain, is a major health care problem. Chronic pain costs the United States up to 635 billion dollars each year in medical treatment and lost productivity.1 In a cross-sectional Internet-based survey of more than 35,000 individuals, the prevalence of chronic pain, defined as chronic, recurrent, or long-lasting pain of at least 6 months’ duration, was 30.7%. The prevalence was higher for female (34.3%) than male (26.7%) respondents and increased with age. Half of respondents with chronic pain experienced daily pain, and 32% of them reported their average pain intensity as severe (= 7 on a scale ranging from 0 to 10).2 In a screening interview in 15 European countries and Israel, 19% of 46,394 respondents reported suffering from pain for 6 months or longer and had experienced pain in the last month and several times during the last week. In addition, 46% of these respondents reported their pain as constant.3 In another study, 90% of the individuals with chronic pain localized their pain to the musculoskeletal structures.4 In a survey of 45,711 American households, 22% of the respondents reported having experienced at least one of five types of orofacial pain in the past 6 months. The most common was tooth pain at 12.2% followed by temporomandibular joint pain at 5.3%.5 It is clear that chronic pain is a major social and economic burden on our society. In fact, pain affects more Americans than diabetes, heart disease, and cancer combined.6 These data indicate that the task of managing head and neck pain is a very substantial one indeed. The problem crosses the lines that demarcate the professions; it should be the concern of all health care professionals. The Dentist’s Responsibility Upon dentists rests a great burden of responsibility for the proper management of pains in and around the mouth, face, and neck. They must therefore be able to differentiate between pains that stem from dental, oral, and masticatory sources and those that emanate from elsewhere. They must become experts in pain diagnosis in order to identify the complaints that are manageable on a dental level with dental methods and techniques. At the same time, they must be able to positively identify complaints that, although may relate to oral and masticatory functioning, in fact stem from causes that cannot reasonably be resolved by ordinary dental procedures. Dentists’ responsibility in managing pain problems of the mouth and face is twofold. Their initial responsibility is diagnostic: They should identify those complaints that are correctable by dental therapy. To do this, they must have accurate knowledge of pain problems arising from sources that are not oral or masticatory. If they cannot make a proper diagnosis, it becomes their responsibility to refer the patient to someone they think is competent in that field of practice. The second responsibility of the dentist relates to therapy. Once the pain complaint is correctly identified as a condition amenable to dental therapy, treatment by the dentist is in order. Whether or not a consultation with another practitioner is needed should be considered in the treatment planning. If therapy at any point does not prove effective as planned, it becomes the dentist’s responsibility to seek the cause of failure by using, if needed, the aid of colleagues. If the condition presented is clearly one that would not be amenable to dental therapy, the patient should be referred to the appropriate health care practitioner. Many pain problems are such that interdisciplinary management is needed. Such problems require a good working relationship between the therapists involved. It is important that dentists understand what their responsibilities in treatment are so that they can conduct their portion of the therapy effectively. They should exercise care not to attempt more than what their share of responsibility requires, and they should not relinquish what should be theirs. A positive, confident competence tempered by a reasonable and cooperative attitude should properly equip dental practitioners to work effectively in any multidisciplinary environment, whether it is wholly dental or dental and medical combined. In recent years, there has been an increase in the dental profession’s interest in orofacial pain disorders. This interest has motivated some universities to establish specialized programs in the field of orofacial pain. The Commission on Dental Accreditation has recently recognized this effort and is now accrediting these programs. This is a very positive step in formalizing and standardizing the field of orofacial pain. A new type of clinician will emerge with unique understanding and experiences in managing orofacial pain disorders and who must have a greater appreciation for the principles of medicine as well as dentistry. The role of this professional in the management of pain is currently being established, making this an exciting time to be involved in this field of study. Historical Note Merskey7 reviewed some of the historical background of modern pain concepts. In ancient times, Homer thought that pain was due to arrows shot by the gods. The feeling that pain is inflicted from an outside source seems to be a...