Differences in ethnic beliefs about the perceived need for local anesthesia for tooth drilling and childbirth labor were surveyed among Anglo-Americans, Mandarin Chinese, and Scandinavians (89 dentists and 251 patients) matched for age, gender, and occupation. Subjects matched survey questionnaire items selected from previously reported interview results to estimate (a) their beliefs about the possible use of anesthetic for tooth drilling and labor pain compared with other possible remedies and (b) the choice of pain descriptors associated with the use of nonuse of anesthetic, including descriptions of injection pain. Multidimensional scaling, Gamma, and Chi-square statistics as well as odds ratios and Spearman's correlations were employed in the analysis. Seventy-seven percent of American informants reported the use of anesthetics as possible remedies for drilling and 51% reported the use of anesthetics for labor pain compared with 34% that reported the use of anesthetics among Chinese for drilling and 5% for labor pain and 70% among Scandinavians for drilling and 35% for labor pain. Most Americans and Swedes described tooth-drilling sensations as sharp, most Chinese used descriptors such as sharp and "sourish" (suan), and most Danes used words like shooting (jagende). By rank, Americans described labor pain as cramping, sharp, and excruciating, Chinese used words like sharp, intermittent, and horrible, Danes used words like shooting, tiring, and sharp, and Swedes used words like tiring, "good," yet horrible. Preferred pain descriptors for drilling, birth, and injection pains varied significantly by ethnicity. Results corroborated conclusions of a qualitative study about pain beliefs in relation to perceived needs for anesthetic in tooth drilling. Samples used to obtain the results were estimated to approach qualitative representativity for these urban ethnic groups.
The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) guidelines, originally developed in the United States, were translated and used to classify TMD patients on physical diagnosis (Axis I) and pain-related disability and psychologic status (Axis II) in a TMD specialty clinic in Sweden. The objectives of the study were to determine if such a translation process resulted in a clinically useful diagnostic research measure and to report initial findings when the RDC/TMD was used in cross-cultural comparisons. Findings gathered using the Swedish version of the RDC/TMD were compared with findings from a major US TMD specialty clinic that provided much of the clinical data used to formulate the original RDC/TMD. One hundred consecutive patients were enrolled in the study. Five patients with rheumatoid arthritis and 13 children or adolescents were excluded. The remaining 82 patients participating in the study comprised 64 women and 18 men. Group I (muscle) disorder was found in 76% of the patients; Group II (disc displacement) disorder was found in 32% and 39% of the patients in the right and left joints, respectively; Group III (arthralgia, arthritis, arthrosis) disorder was found in 25% and 32% of the patients in the right and left joints, respectively. Axis II assessment of psychologic status showed that 18% of patients yielded severe depression scores and 28% yielded high nonspecific physical symptom scores. Psychosocial dysfunction was observed in 13% of patients based on graded chronic pain scores. These initial results suggest that the RDC guidelines are valuable in helping to classify TMD patients and allowing multicenter and cross-cultural comparison of clinical findings.
This study explored ethnic differences in perceptions of pain and the need for local anesthesia for tooth drilling among age- and gender-matched Anglo-American, Mandarin Chinese, and Scandinavian dentists (n = 129) and adult patients (n = 396) using a systematic qualitative research strategy. Semistructured qualitative interviews determined: (a) the relative frequency of use or nonuse of anesthetic for similarly specified tooth drilling, (b) the reasons for nonuse of anesthetic as reported by dentists about their patients, and (c) the distribution of reasons for not using anesthetic. American dentists (n = 51) reported that about 1% of their adult patients did not use anesthetic compared with 90% among Chinese (n = 31) and 37.5% among Scandinavian dentists (n = 40). Of patients, Americans (n = 112) reported 6% nonuse of anesthetic for tooth drilling compared with 90% of 159 Chinese and 54% of 125 Scandinavians. Reasons among Anglo-Americans and Scandinavians were similar (ranked): the sensation was tolerable, to avoid numb feelings afterwards, and fear of injections. Danish patients were an exception; the fact that they had paid extra and out-of-pocket for anesthetic ranked second. In contrast, Chinese dentists made their decisions not to use anesthetics because they explained drilling as only a suan or "sourish" sensation, whereas injections were described as "painful." It was concluded that ethnic pain beliefs and differences in health-care systems are powerful psychosocial variables that affect pain perception and the perceived need for anesthetic.
AIMS: The aim of this study was to determine the prevalence of pain that is related to temporomandibular disorders (TMD), gender differences, and perceived treatment need in children and adolescents at a public dental clinic in Linköping, Sweden. METHODS: A total of 862 children and adolescents aged 12 to 18 years received a questionnaire and their jaw opening was measured. Those who reported pain once a week or more in the masticatory system received a more comprehensive examination, including the Research Diagnostic Criteria for TMD and a neurologic examination (group 1). Group 2 reported pain less than once a week. RESULTS: Seven percent of subjects (63/862) were diagnosed with TMD pain. Both genders exhibited similar distributions of TMD diagnoses, except that myofascial pain was significantly more common in girls than in boys. Prevalence of pain once a week or more was reported as: 21% in the head; 12% in the temples; and 3% in the face, temporomandibular joint, or jaws. The prevalence of TMD-related pain was significantly higher in girls than in boys. Self-reported TMD symptoms were significantly more common (P