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Reliability of intraoral quantitative sensory testing (QST)
Malmö högskola, Faculty of Odontology (OD).ORCID iD: 0000-0002-7989-1541
Malmö högskola, Faculty of Odontology (OD).
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2010 (English)In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 148, no 2, p. 220-226Article in journal (Refereed)
Abstract [en]

The German Research Network on Neuropathic Pain (DFNS) has recommended a protocol with 13 quantitative sensory testing (QST) measures for detecting somatosensory abnormalities. Reliability is an important scientific property and has been adequately tested for cutaneous QST. This study evaluates intraoral sites for which no reliability trials have yet been published. Inter- and intra-examiner reliability of 13 QST measures at intra- and extraoral trigeminal sites were investigated. Twenty-one healthy volunteers from Malmö University, Malmö, Sweden (13 women and 8 men, mean age 40.4 years, range 24–71) participated. Two independent examiners previously trained in the DFNS QST protocol examined the participants using the entire protocol. Each participant was examined twice on the same day, once by each examiner (inter-examiner reliability). After 1–3 weeks, one examiner re-examined all participants (intra-examiner reliability). The measurements were made on the skin of the right cheek, the tip of the tongue, and bilaterally on the gingival mucosa of the upper premolar region. The intraclass correlation coefficient (ICC) or kappa was used to calculate variations. Most tests had acceptable to excellent inter-examiner (ICC 0.41–0.89) and intra-examiner (ICC 0.43–0.87) reliability. For each test, inter- and intra-examiner reliabilities at intra- and extraoral sites were similar. No significant differences between right and left sides were found intraorally. We conclude that inter- and intra-examiner reliabilities of most QST measures are acceptable for assessing somatosensory function in the orofacial region.

Place, publisher, year, edition, pages
Elsevier, 2010. Vol. 148, no 2, p. 220-226
Keywords [en]
Quantitative sensory testing, Somatosensory testing, Reliability, Orofacial pain, Chronic intraoral pain, Neuropathic pain, Trigeminal nerve
National Category
Dentistry
Identifiers
URN: urn:nbn:se:mau:diva-15286DOI: 10.1016/j.pain.2009.10.024ISI: 000273894600010PubMedID: 20022428Scopus ID: 2-s2.0-74449091155Local ID: 9911OAI: oai:DiVA.org:mau-15286DiVA, id: diva2:1418807
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2024-02-05Bibliographically approved
In thesis
1. Chronic intraoral pain - assessment of diagnostic methods and prognosis
Open this publication in new window or tab >>Chronic intraoral pain - assessment of diagnostic methods and prognosis
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall goal of this thesis was to broaden our knowledge of chronic intraoral pain. The research questions were:•What methods can be used to differentiate inflammatory, odontogenic tooth pain from pain that presents as toothache but is non-odontogenic in origin?•What is the prognosis of chronic tooth pain of non-odontogenic origin, and which factors affect the prognosis?Atypical odontalgia (AO) is a relatively rare but severe and chronic pain condition affecting the dentoalveolar region. Recent research indicates that the origin is peripheral nerve damage: neuropathic pain. The condition presents as tooth pain and is challenging to dentists because it is difficult to distinguish from ordinary toothache due to inflammation or infection. AO is of interest to the pain community because it shares many characteristics with other chronic pain conditions, and pain perpetuation mechanisms are likely to be similar. An AO diagnosis is made after a comprehensive examination and assessment of patients’ self-reported characteristics: the pain history. Traditional dental diagnostic methods do not appear to suffice, since many patients report repeated care-seeking and numerous treatment efforts with little or no pain relief. Developing methods that are useful in the clinical setting is a prerequisite for a correct diagnosis and adequate treatment decisions.Quantitative sensory testing (QST) is used to assess sensory function on skin when nerve damage or disease is suspected. A variety of stimuli has been used to examine the percep¬tion of, for example, touch, temperature (painful and non-painful), vibration, pinprick pain, and pressure pain. To detect sensory abnormalities and nerve damage in the oral cavity, the same methods may be possible to use.Study I examined properties of thermal thresholds in and around the mouth in 30 pain-free subjects: the influence of measurement location and stimulation area size on threshold levels, and time variability of thresholds. Thresholds for cold, warmth and painful heat were measured in four intraoral and two extraoral sites. Measurements were repeated 3 times over 6 weeks, using four sizes of stimulation area (0.125–0.81 cm2). The threshold levels were highly dependent on location but less dependent on measuring probe size and time variability was small, and this knowledge is important for the interpretation of QST results.Study II applied a recently developed standardized QST examination protocol (intended for use on skin) inside the oral cavity. Two trained examiners evaluated 21 pain-free subjects on three occasions over 1–3 weeks, at four sites—three intraoral and one extraoral. Most tests had acceptable reliability and the original test instruments and techniques could be applied intraorally with only minor adjustments. Study III examined the value of cone-beam computed tomography (CBCT) in pain investigations. Twenty patients with AO and 5 with symptomatic apical periodontitis (inflammatory tooth pain) participated. The results indicate that when AO is suspected, addition of CBCT can improve the diagnostic certainty compared to sole use of periapical and panoramic radiographs, especially because of the superior ability of CBCT to exclude inflammation as the pain cause.Study IV assessed the long-term prognosis of AO, and analyzed potential outcome predictors.. A comprehensive questionnaire including validated and reliable instruments was used to gather data on patient and pain charac¬teristics and pain consequences from 37 patients in 2002 and 2009. Thirty-five percent of the patients reported substantial overall improvement at follow-up, but almost all still had pain of some degree after many years. The initial high level of emotional distress was unchanged. Low baseline pain intensity predicted improvement over time.

Place, publisher, year, edition, pages
Malmö University, Faculty of Odontology, 2011
Series
Swedish Dental Journal : Supplement, ISSN 0348-6672 ; 220
Keywords
Neuropathic pain, Orofacial pain, Trigeminal pain, Clinical studies, Prognosis, Diagnostic methods, Quantitative sensory testing, QST, Chronic pain, Endodontics
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-7711 (URN)22338784 (PubMedID)2-s2.0-84859379043 (Scopus ID)12563 (Local ID)978-91-7104-387-0 (ISBN)12563 (Archive number)12563 (OAI)
Note

Note: the papers are not included in the fulltext online.

Paper IV in dissertation as manuscript with title "Longterm prognosis of atypical odontalgia. A 7-year prospective study"

Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-12-02Bibliographically approved

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Pigg, MariaList, Thomas

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