DZZ International, 01/2021

What are the clinical signs and possible causes of idiopathic progressive condylar resorption? Background The term "idiopathic progressive condylar resorption" has appeared in literature since the late 1990s. It is a rare disease that involves the resorption of the mandibular condyle and it is accompanied by a progres¬sive change of the bite position towards an Angle Class II [2, 3, 30, 46]. In the majority of cases, both condyles are affected. The patient group consists mainly of young women subsequent to orthodontic or surgical treatment. The average age is 20.5 years.

Problem: When patients report pronounced physical complaints without sufficient somatic findings to substantiate them, practitioners sometimes refer to these patients as being "problem patients" or "difficult patients". When such an attribution is assigned, it usually denotes a difficult interpersonal relationship between practitioners and patients, which can be further exacerbated by deficits related to professional expertise, communication and dental fee schedules. Discussion/Conclusion: On the basis of examples of persistent temporomandibular disorders/orofacial pain, it is recommended that professionally practicing dentists should live up to their responsibility and trust given to them by patients. For that purpose, dentists must be aware of their limits of compe-tence and be cautious about overestimating their abilities. There are not only "difficult patients"; there are also "difficult dentists". Keywords: health care provider's role, clinical decision-making, communication, craniomandibular disorders, dentist-patient relationship, interpretation, pattern recognition

Introduction: Speculative etiological assumptions and blame are widespread in the case of medically unexplained symptoms, and particularly in the case of pain. Materials and Methods: In the article, findings are presented that demonstrate a high inter- and intra-individual variance of pain and thus the "subjectivity" of pain experiences. Discussion/Conclusion: The meaning of the treatment context is discussed as well as possible errors and "traps" in the treatment. A critical reflection of one's own diagnostic and therapeutic routines is encouraged. Keywords: ICD-11, chronic pain, nocebo, patient-doctor relationship, placebo, stigmatization

Introduction: Until recently "somatoform prosthesis intolerance" covered a wide range of patients with diffuse symptoms. Material and Methods: Meanwhile, new dental conditions have been established so that it is possible to differentiate among Burning Mouth Syndrome (BMS), atypical odontalgia (persisting [idiopathic] dental alveolar pain), occlusal dysesthesia, and somatoform prosthesis intolerance. These clinical pictures can be categorized under diagnosis of "somatic symptom disorders", which was newly established in 2015. It is marked by a duration of symptoms of more than 6 months, intense preoccupation with those symptoms, and a significantly reduced capability to cope with everyday life. The formerly used diagnosis "somatoform prosthesis intolerance" can likewise be understood as a subcategory of specific dental somatic symptom disorder. Conclusion: Based on available clinical experience it can be assumed that this diagnosis will be particularly applicable for patients that are equipped with objectively well-fitting fixed and/or removable dentures but experience difficulties with them and therefore attract attention with somatic stress symptoms. A structured approach is necessary for initial and basic treatment. This is described by the S3-guideline "functional disorders". Keywords: atypical odontalgia, burning mouth syndrome, functional disorders, occlusal dysesthesia, somatic stress disorder, somatoform prosthesis intolerance

Introduction: Patients complaining of uncomfortable and unpleasant tooth contacts are encountered in the dental practice time and time again, as well as in the fields of physiotherapy, pain therapy, and psychotherapy. These tooth contacts are neither clinically identifiable as premature contacts nor associated with other disorders (e.g., of the periodontal tissues, dental pulp, masticatory muscles, or temporomandibular joint). It is not uncommon for patients to experience this perceived occlusal discomfort as a constant impairment of their oral or physical well-being. This is often accompanied by psychosocial problems. The cases discussed in this article often concern patients suffering from occlusal dysesthesia (OD), although a differential diagnosis must always be carried out to distinguish OD from occlusal disease. Methods: This article presents clinical features of occlusal dysesthesia that are relevant to everyday practice. These features are explained based on the current guideline "Occlusal Dysesthesia – Diagnostics and Management" published by the Association of the Scientific Medical Societies in Germany (AWMF) and by means of case examples. Psychopathological factors, neuro-plasticity, phantom phenomena, and changes to the transmission of proprioceptive stimuli and perception have been discussed as etiological factors of OD; however, the exact connections have not yet been extensively researched or fully understood. Invasive occlusal therapy is not advisable. The use of dental splints is also a controversial topic of discussion in the literature. Patient counselling and education about the nature of OD ("information therapy") that aims to explain and defocus is a recommended measure. Other therapeutic alternatives include cognitive behavioral therapy, specialist medical treatment of possible comorbid psychological factors, pharmacotherapy, and the prescription of physical activity. Conclusion: Despite professional therapy, treatment of affected patients is often unsuccessful. Keywords: false bite, lost bite, occlusal discomfort, occlusal disease, occlusal dysesthesia, occlusion