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PURPOSE To evaluate the clinical utility of a salivary alpha-amylase (sAA) biosensor for assessing oral surgery-related stress responses and the differential effect of the personality trait of pain catastrophizing. PATIENTS AND METHODS We conducted a prospective, cohort study of 76 healthy subjects who underwent elective removal of their third molars. Along with subjects’ self-reports of anxiety and pain, biosensor-facilitated measurements of sAA levels were obtained at multiple time points during the preoperative consult, surgery, and post-surgical follow-up visits. Additionally, subjects completed the Pain Catastrophizing Scale at baseline. Mixed-effect regression models examined change in sAA and self-report ratings within and across visits, and the contribution of pain catastrophizing. RESULTS sAA levels were lower during surgery and post-surgical follow-up compared to the consult visit (p < .01). sAA decreased during the surgery visit (p < .05), and did not change during the consult or follow-up visits. Individuals who reported greater helplessness responses to pain manifested higher sAA levels during the surgery visit (p < .05). Self-reported anxiety ratings were highest during the surgery visit, and pain ratings were highest during the follow-up visit. CONCLUSION sAA did not show predicted elevations during the surgery visit compared to the consult and post-surgical follow-up visits, or increases during the surgery visit. However, individuals who reported responding to pain with helplessness had larger sAA levels in anticipation of surgery, providing proof of concept for the value of point-of-care assessments of surgery-induced stresses and the differential effect of personality traits.

Clinical features of masticator-space abscess (MSA) are very similar to those of parotitis or temporomandibular disorder (TMD), making early differential diagnosis difficult. Local causes of MSA include nerve block anesthesia, infection after tooth extraction, and trauma to the temporomandibular joint (TMJ); the systemic cause is immunodeficiency. Odontogenic causes account for most etiologies, but there are also unusual causes of MSA. A 66-year-old male patient visited the emergency room (ER) presenting with left-side TMJ pain three days after receiving an acupressure massage. He was tentatively diagnosed with conventional post-trauma TMD and discharged with medication. However, the patient returned to the ER with increased pain. At this time, his TMD diagnosis was confirmed. He made a third visit to the ER during which facial computed tomographic (CT) images were taken. CT readings identified an abscess or hematoma in the left masticator space. After hospitalizing the patient, needle aspiration confirmed pus in the infratemporal and temporal fossa. Antibiotics were administered, and the abscess was drained through an incision made by the attending physician. The patient's symptoms decreased, and he was discharged.