Studies of individuals with orofacial discomfort complaints. An investigation of a group of patients who related their sufferings to effects of dental materials and constructions.

This thesis is based on seven studies. The aims of these studies were to investigate a series of consecutive patients with orofacial and general sensations and complaints of discomfort, which the patients assumed to be caused by galvanic currents created by metallic dental fillings and restorations, as well as contact allergy to both metallic and non-metallic substances in dental materials. Studies I and II described the patients' symptoms and complaints, as well as the clinical findings of many odontological and medical examinations. A widely varying symptom panorama and numerous clinical findings, both oral and general, have been found which could not be explained by a single etiological factor. A combination of many factors, such as general health problems, side effects of medication, psychosocial problems, including stressful life events and complications due to the chronicity of the pain formed the background to the oral and general complaints of these patients. The salivary and microbiological conditions and patch test results were presented in studies III and IV. The saliva flow rate, pH and cariogenic bacteria level as well as contact allergy to metallic and non-metallic substances known as allergens, were not significantly different, but buffer capacity and saliva conductance did differ. A laboratory investigation of the corrosion behaviour of dental amalgams and gold alloys in natural saliva and saline solutions was performed (Study V) and the corrosion state of dental amalgam fillings and constructions was examined (Study VI). Special laboratory and clinical methods and apparatus were constructed and used. No differences between electrode potentials of the amalgam fillings and constructions in patients with and without orofacial discomfort complaints were measured. Study VII presented an analysis of the outcome of the treatments applied. The treatment was based on each patient's symptoms and signs and probable diagnosis. Besides conventional dental, stomatognathic and medical treatment, metallic constructions were removed in 54% of the patients. The initial treatment result was favourable in 80% but recurrences were frequent. It was concluded that these patients need a careful oral examination and dental treatment of observed local pathosis and defects of dental constructions, but removal of metallic fillings and constructions should be avoided when not indicated. Many of these patients require medical consultation and treatment, and collaboration between dentist and the physician is recommended.