Nutrition and Oral Medicine (Nutrition and Health)

134 Part III / Nutrition and Oral Healthhave symptoms of a fleeting sharp pain elicited by exposure to a stimulus such as coldor sweet. Chronic and untreated pulpal disease progresses to an irreversible pulpitis, acondition resulting in pulpal death. This produces symptoms of poorly localized lingeringpain described as boring or gnawing. It is aggravated by eating or exposure to a coldstimulus, as well as by lying down (i.e., many patients awake from their sleep withpulpitis pain). Pulpitis progression produces even more pain, frequently severe in nature,aggravated by heat, and often relieved by application of cold. Occasionally, chronicpulpitis results in the spontaneous development of pain. Pulpal death and necrosis canlead to an acute apical periodontitis and an acute apical abscess, both of which may causea severe throbbing pain localized to the tooth involved, and regional lymphadenopathy.Ultimately, the abscess can disseminate into a cellulitis and fascial space infection, whichwill cause facial swelling, pain in the regional lymph nodes, fever, malaise, difficultyeating or opening the mouth, and dysphagia. In extreme cases, the infection and affiliatedinflammatory products can become life threatening if vital structures become involved(e.g., dyspnea caused by compromised airway, infection of mediastinum, cavernoussinus). Periodontal pain is usually associated with an acute periodontal abscess, whichcan also result in serious sequelae.Because odontogenic pain is generally acute in nature, prompt and effective treatmentby tooth restoration, root-canal therapy, extraction, or periodontal curettage willresult in the resolution of pain. As such, the nutritional impact is generally short-livedunless the treatment for the pain results in loss of teeth and associated sequelae (seeSection 1.1.1.). However, in patients who are at risk for or have malnutrition and/or lackaccess to emergency care, the inability to chew may have a pronounced nutritionalimpact. Appetite and eating may be compromised by frequent use of analgesics, whichmay impact GI function and/or narcotics used for severe pain, which may diminishappetite (see Chapter 6).1.3.2. CHRONIC OROFACIAL PAINIn chronic pain disorders such as myofascial pain (MFP), eating ability may behampered by pain. In studies of individuals with MFP, masticatory muscle functionmay fatigue more quickly than in individuals without MFP and raise pain scores (34,35).Raphael et al. (35) studied patients with MFP; of 61 participants, 88.5% indicateddifficulty chewing, 86.9% indicated difficulty eating hard foods, and 24.6% indicateddifficulty eating soft foods. A trend, although not significant, was found for individualswho reported eating difficulty for hard foods; these subjects consumed a greater percentageof calories from protein. Those who experienced difficulty eating soft foodswhen compared to those who did not report this difficulty had a reduced intake of totalcalories (although not significant). Although comparison of the macro- and micronutrientintake of MFP patients to the US population revealed no significant differencein nutrient intake per se, when multiple linear regression was used, a significant differencein dietary fiber intake was noted for individuals with higher pain levels. Therewas a significant negative relationship between pain severity and dietary fiber intake(p < 0.01). The results of this study supported the concept that intake of high-fiberfoods is more difficult for individuals with MFP. Dietary recommendations for patientswith MFP should include high-fiber foods that do not require extensive masticatoryfunction.