Roxanne Bavarian, DMD, DMSc, Olivia Begasse de Dhaem, MD, Jeffry R Shaefer, DDS, MS, MPH; Implementing Virtual Case-Based Learning in Dental Interprofessional E

Over three decades ago, hundreds of predominantly young women with temporomandibular joint pain and other symptoms were implanted with a prosthetic device composed of Proplast-Teflon that subsequently caused considerable harm, with patients developing chronic pain, dysfunction, and disability. This perspective review presents such a patient who suffered for decades with severe pain despite extensive pharmacotherapy, injection therapy, multiple surgeries, and behavioral health interventions. The details of the origin and subsequent events regarding the use of Proplast-Teflon interpositional implants in the temporomandibular joint are described with resources from several different perspectives. The lessons learned demonstrate failures at the federal, professional, and individual level.

Objective: This study aimed to describe the clinical characteristics and prevalence of different painful phenotypes in head and neck cancer (HNC)-related pain. Materials and Methods: A cross-sectional study was conducted on 100 patients who presented with HNC-related pain. All patients underwent a comprehensive clinical assessment and were stratified in one or more painful phenotypes constructed based on the International Classification for Orofacial Pain, first edition, and International Classification for Headache Disorders, third edition. Results: Among the participants included, 68% were male, and the mean age of the cohort was 49.71 ± 14.14 years. The most prevalent cancer sites were the tongue (29%) and buccal mucosa (24%). The average pain intensity was 5.88 ± 2.53 on an 11-point numeric verbal pain rating scale, where 0 was indicative of “no pain” and 10 was suggestive of “worst pain imaginable”. However, the worst pain intensity over the last month was 8.95 ± 1.53. The average number of pain sites per patient was 6, and the most common pain descriptors were dull ache, burning, and sharpness. Myofascial pain, jaw bone pain, and burning pain disorder were the most common phenotypes, and on average, three different phenotypes co-existed. Conclusion: HNC-related pain has a varying and complex clinical profile, which may mirror the pain profiles of primary pain disorders, such as myofascial pain, jaw bone pain, or burning pain disorders, and often presents together as a cluster of phenotypes. Plain language summary: The clinical presentation of head and neck cancer (HNC)-related pain varies considerably. This study assessed 100 patients with HNC-related pain. It stratified their symptoms into one or more known painful disorders based on the International Classification for Orofacial Pain, first edition and International Classification for Headache Disorders, third edition. It was found that HNC-related most commonly resembled myofascial pain, jaw bone pain, and burning pain disorder. On average, features of three different types of painful disorders co-existed. These results help illustrate the uniqueness and difficulty associated with managing HNC-related pain.