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PubMed1979

Lethal toothache: parapharyngeal cellulitis complicating dental infection.

Three patients with parapharyngeal cellulitis arising from dental infection were seen by the Medical Service over a period of ten months. Respiratory distress and/or pharyngeal discomfort prompted all patients to seek medical aid. The extent of infection within the parapharyngeal space, the potential for life-threatening complications, and the significance of the dental lesions were not appreciated initially in all cases. Despite early antibiotic therapy, one patient died and one incurred severe neurologic sequelae. Early recognition, use of antibiotics effective against anaerobic bacteria, and prompt surgical drainage are mandatory to prevent considerable morbidity and mortality. Control of the airway is the most important therapeutic maneuver leading to a favorable outcome.

Adult↗
PubMed2006

Dental Discomfort Questionnaire: assessment of dental discomfort and/or pain in very young children.

OBJECTIVE: To present and analyse the Dental Discomfort Questionnaire (DDQ) for very young children and to assess the possible differences in pain-related behaviours displayed by children with or without reported toothache, and by children with or without decayed teeth. METHODS: Based on parental interviews of toddlers referred to a dental care practice 12 pain-related behaviours were identified which formed the DDQ. The DDQ was filled out by parents on behalf of their children (n = 146; mean age 47 months). Two-third (n = 94) of the children were referred to a special dental care centre and one-third (n = 52) were controls from a day care centre. RESULTS: The results show that the 12 items of the DDQ seem to measure one dimension. However, four items do not correlate with the presence of reported toothache, when these items are removed the DDQ-8 has a satisfactory reliability. All eight behaviours from the DDQ-8 occur significantly more often in children with decayed teeth and toothache than in children without decayed teeth or toothache. Especially behaviours concerning eating or brushing teeth are found to be more often present in children with decayed teeth and toothache. CONCLUSIONS: It seems useful to take the child behaviour into account in assessing toothache. The DDQ has shown to be a reliable instrument, which could be helpful in the future for both parents and dentists in identifying toothache in young children.

Child Behavior↗
PubMed1999

The prevalence and impact of dental pain in 8-year-old school children in Harrow, England.

OBJECTIVE: To assess the prevalence, severity and impact of dental pain. DESIGN: Cross-sectional survey. SETTING: Schools in the London Borough of Harrow, England, in the summer term of 1995. SUBJECTS AND METHODS: The base population were all 2,300 8-year-old school children in Harrow. A cluster sampling of schools based on quotas from all postcode areas in Harrow was used. Data were collected through interviews with the children. MAIN OUTCOME MEASURES: Prevalence of previous toothache; prevalence of toothache in the previous 4 weeks; prevalence of toothache in the previous 4 weeks which resulted in a visit to the dentist, in stopping playing, eating, sleeping, going to school and taking painkillers. RESULTS: Of the 664 sample of children in the participating schools, 589 were interviewed (88.7%). The frequency of previous toothache was 47.5% (95% CI, 44-52) and dental pain caused crying in 17.7% (95% CI, 15-21) of children. 7.6% (95% CI, 5-11) of children had pain in the previous 4 weeks (45 children). Among these 45 children, this recent pain resulted in a visit to the dentist in 41.9% (19 children, i.e. 3.2% of all children), in stopping playing in 26.7% (12 children, i.e. 2.0% of all children), eating in 73.3% (33 children, i.e. 5.6% of all children), sleeping in 31.1% (14 children, i.e. 2.4% of all children) and in going to school in 11.1% (5 children, i.e. 0.8% of all children). CONCLUSION: Toothache in children is a sizeable problem in Harrow and had substantial consequences for children and their guardians. Freedom from disabling dental pain/discomfort is an outcome indicator of oral health and could be used as an explicit goal by dental systems. It is important to note however, that the present study did not assess the extent to which the dental pain was associated with avoidable dental problems as opposed to normal physiological processes. It is important that future work try and separate the prevalence of dental pain caused by physiological from avoidable pathological factors. In addition, future work is needed to assess how effectively and efficiently dental services are responding to people suffering with dental pain.

Child↗
PubMed1994

Effects of experimental and clinical noxious counterirritants on pain perception.

It is commonly accepted that application of a sustained noxious stimulus frequently suppresses the perception of pain. In this investigation, we have determined whether painful forearm ischemia suppresses tooth pain resulting from an acute irreversible pulpitis. We have also determined whether the physiological responses to toothache alter the perception of pain evoked by experimental procedures. Ten male subjects experiencing a painful toothache (group TA) and 7 age-matched pain-free male subjects (group PF) participated in these studies. During session 1, heat pain threshold and tolerance values were determined for both groups. The times to ischemic pain onset and ischemic pain tolerance were determined for both groups using the submaximal effort tourniquet procedure. The effect of the tourniquet procedure on the intensity, unpleasantness, and spatial distribution of toothache was also assessed. Session 2 was conducted on 7 TA and 7 PF subjects 1 week later and was conducted like session 1 with the exception that group TA was not experiencing tooth pain during this session. Measures of thermal pain perception and forearm ischemic pain perception were not altered by the occurrence of toothache. In contrast, sustained noxious forearm ischemia produced a marked reduction in the intensity, unpleasantness and spatial distribution of pulpal pain. These effects on pulpal pain remained for at least 5 min after removal of the tourniquet while the arm was pain free. These findings suggest that a noxious conditioning stimulus does not universally inhibit pain perception but instead depends on unidentified interactions between the noxious test and conditioning stimuli.

Acute Disease↗
PubMed1978

Utilization of dental care in Finnish industrial population.

Ninety-three percent of the 300 employees of a paper mill in central-eastern Finland answered a questionnaire in the context of a clinical dental survey. One third had visited the dentist annually, 22% once in 2 years and the rest irregularly. Dental visit frequency of females was somewhat higher than that of males. People in younger age groups and higher income groups used more dental services, whereas those who had dentures used clearly less dental services than others. Subjective assessment of treatment need was the main reason for dental visits, more than half of the subjects had attended the dentist the last time because of self-assessed need. Thirty-eight percent went to the dentist because of toothache and only 9% for regular check-up. Although more than one third had gone to the dentist because of toothache only one third of those who had toothache during the preceding year had visited the dentist during that period. People without toothache, in fact, used more dental services than those who had had it.

Adult↗
PubMed2001

Epidemiology of dental pain and dental caries among children and adolescents.

OBJECTIVE: The aim was to critically evaluate published epidemiological studies of dental pain among children and adolescents, primarily to answer the question 'Does the probability of dental pain increase as the population level of dental caries increases?'. METHOD: The MEDLINE database was searched electronically for epidemiological studies of dental pain and caries, and supplemented with hand searching of bibliographies. Ecological associations were evaluated visually, by plotting published caries levels and dental pain prevalence, and quantitatively, by computing correlation coefficients between community-level caries experience (dmft and DMFT) and prevalence of toothache in those communities. RESULTS: Most studies enumerated dental pain by asking parents whether their child had ever experienced toothache, with reported prevalence ranging from 5 to 33% among countries. Lifetime prevalence was greater among older children and among children from lower socio-economic groups. Ecological analysis of published data revealed moderate to strong correlations (Spearman's coefficient 0.53 to 0.83) between caries experience and prevalence of toothache. Correlations were stronger (0.86 to 0.95) among lower social classes, consistent with a 5 to 6% increase in probability of toothache for each additional deciduous tooth with caries experience. The direction and magnitude of these ecological associations was similar to person-level correlations. CONCLUSION: Dental pain is highly prevalent among children, even in contemporary populations with historically low levels of caries experience. Dental pain is consistently associated with population levels of caries experience, the association being most apparent in lower socioeconomic groups with reduced access to care.

Adolescent↗
PubMed1990

Orofacial pain in patients with sickle cell disease.

The potential danger of low oxygen tension to patients with sickle cell disease is widely known. However, less well known is the phenomenon of patients with sickle cell disease presenting with toothache in the absence of any dental pathology. This study investigated the experience of orofacial pain in three matched groups, comprising patients with sickle cell disease, sickle cell trait and patients with no known blood dyscrasia. There were no differences in pain experience between those groups with sickle cell trait and no known blood dyscrasia. The sickle cell disease patients experienced significantly more orofacial pain in the same 12-month period than the other groups. The pain was also more frequent and of longer duration. In two-thirds of those sickle cell disease patients who experienced toothache, no dental pathology was found, in direct contrast to patients with trait or no known blood dyscrasia. Sickling of blood cells within the dental pulp in a sickle cell crisis may result in pain within teeth. These patients may then present as experiencing toothache in the absence of any dental pathology. General dental practitioners should be aware of this phenomenon when providing care for these susceptible patients.

Adolescent↗
PubMed2005

Dental discomfort questionnaire for young children before and after treatment.

OBJECTIVE: To present a follow-up using the Dental Discomfort Questionnaire (DDQ) before and after the treatment of children, under the assumption that the number of toothache-related behaviors diminishes as a result of treatment, and to see whether this effect is related to the site of the carious teeth or to the treatment itself. METHODOLOGY: Sixty-one parents completed the DDQ before and after the treatment of their child, aged between 30 and 59 months. The available dental records were used to assess the status of the caries and the consecutive treatment. RESULTS: Overall, there was a significant decrease in the average number of post-treatment behaviors displayed by children. However, children with extractions during treatment or children with caries in their front teeth did not change their behavior. These children continued to have difficulty with chewing and biting. CONCLUSIONS: The dental treatment of children leads to reduced toothache-related behaviors. Our study showed the DDQ to be a useful instrument for acquiring insight into the behavioral aspects of young children as a consequence of toothache or dental treatment, thereby underlining the importance of a behavioral approach in young children.

Child↗
PubMed1999

Explanatory models for clinically determined and symptom-reported caries indicators in an adult population.

The aim of the present study was to analyze possible indicators of: (i) relative number of decayed and filled teeth, (ii) relative number of decayed teeth, (iii) subjectively reported toothache, and (iv) sensitive teeth, and to find explanatory models for these phenomena. Independent variables from three domains were used: (i) socio-economic factors, (ii) general health and health-related lifestyle, and (iii) dental attitudes and behaviors. The study basis was validated questionnaires from all 50-year-olds in 2 Swedish counties (n = 8888), response rate 71% (n = 6343). For a 20% subsample (58% participation) the DFT and DT were determined by calibrated dentists. Analyses were done with logistic and multiple regression. The variables born outside Sweden, gender, education, shift work, satisfaction with dental care, fear and care utilization were associated with DFT/number of teeth. For DT/number of teeth, the direction of association was reversed for the variables born outside Sweden and gender. Social class, education, general health, and use of tobacco were further covariates. Good oral hygiene gave a lower ratio of DT. For the logistic regression model of toothache, residence in cities and satisfaction with dental care had lower probability for toothache reports, while born outside Sweden, mouth dryness, use of pharmaceuticals, tobacco, fear, and high utilization increased this probability. In general, the association pattern was as could be expected: immigrants, working class, low education, smoking, dissatisfaction with dental treatment and low utilization all appeared as risk factors for both the clinically determined caries indicators, but not necessarily for subjective symptom reports. Only fear of dental treatment showed a consistent positive association with all the indicators.

Attitude to Health↗
PubMed2004

Demographic and socio-economic factors associated with dental health among older people in NSW.

OBJECTIVE: To investigate the association between oral health status and social, economic and demographic factors in community-dwelling older people in New South Wales (NSW). METHODS: Binary and multinomial logistic regression analyses were used to examine the associations between measures of oral health status (edentulous/dentate, and the frequency of toothache or mouth or denture problems in the previous 12 months) and demographic and socio-economic factors using data from the NSW Older People's Health Survey 1999. RESULTS: After adjusting for other factors, being edentulous was associated with being older, having no private dental insurance, being female, leaving school at less than 15 years of age, not being financially comfortable, not being a homeowner, living in a rural area, and being unable to travel alone. Among both dentate and edentulous people, increasing age and being able to travel independently were associated with decreased reporting of toothache, mouth or denture problems; while not being financially comfortable was associated with increased reporting of toothache or mouth or denture problems. The frequency of mouth or denture problems was not found to be independently associated with having private dental insurance nor with holding a health concession card. CONCLUSIONS: Among older people in NSW, oral health is associated with a range of demographic and socio-economic factors. The results suggest that better oral health among older people is associated with a capacity to pay out-of-pocket dental expenses rather than with private dental insurance or having access to public-funded dental care.

Aged↗
PubMed1990

Patients' preference for exodontia versus preservation in Malaysia.

A total of 537 dentate adults from nine randomly selected government dental centers in three states in Malaysia were interviewed to assess their preference for either exodontia or preservation of teeth when they experience toothache, or have carious anterior or posterior teeth. The assumptions tested were i) patients prefer exodontia rather than preservation when they have toothache, and ii) patients are more willing to have posterior teeth extracted than anterior teeth for caries. Both these assumptions were rejected. Even though the majority of the subjects preferred preservation (59%) when having toothache, exodontia was the treatment of choice in a large proportion of subjects (41%). Significant differences in preference were found among the various ethnic, educational, income, and age groups. However, when ethnicity was held constant, binary regression indicated that the variations observed were determined by education, income, and age groups and not by ethnicity.

Adolescent↗
PubMed1996

Intra-oral distribution and impact of caries experience among South Australian school children.

This report describes the intra-oral distribution of caries and frequency of reported toothache using data from 9690 South Australian children aged 5-15 years. School dental therapists and dentists recorded dmfs and DMFS data and a questionnaire to parents sought information about toothache and its impact. There were higher levels of caries experience in deciduous teeth (mean 6-year-old dmfs = 2.61) compared with permanent teeth (mean 12-year-old DMFS = 1.15). In the deciduous dentition: between 11.4 per cent (9-year-olds) and 37.7 per cent (5-year-olds) of total dmfs was present as untreated decay; between 39.1 per cent (7-year-olds) and 42.8 per cent (10-year-olds) occurred on interproximal surfaces; and between 2.0 per cent (10-year-olds) and 27.8 per cent (5-year-olds) occurred in anterior teeth. In the permanent dentition, the majority of permanent caries experience occurred as fillings in pits and fissures of first molars and involved a single surface. Between 11.8 per cent (5-year-olds) and 31.8 per cent (12-year-olds) of children had a reported history of toothache, although the figure exceeded 50 per cent among children with all three forms of pit/fissure, interproximal and smooth-surface caries experience. The observed pattern of caries provides the basis for continued use of fissure sealants as a preventive measure among school children.

Adolescent↗
PubMedDate not supplied

Oral health status of preschool children attending Head Start in Maryland, 2000.

PURPOSE: The objective of this study was to determine the oral health status of preschool children attending Head Start Centers in Maryland. METHODS: Clinical caries examinations were conducted on 482 children between ages 3-5 from 37 Maryland Head Start Centers in 2000. Additionally, 560 questionnaires were completed by their caretakers regarding their child's access to care, potential caries risk factors and history of toothaches. RESULTS: The overall prevalence of untreated decay was 52%, with a higher prevalence found in rural than urban centers (64% vs 48%). For all children, the mean decayed, filled surfaces (dfs) was 3.64, while the mean decayed surfaces (ds) was 2.90. For those who had caries experience, the dfs was 6.67 and the ds was 5.32. The percentage of children with caries increased by age from 43% for three-year-olds to 62% for four-year-olds. Of those children with caries experience, 17% had complained of a toothache and 9% reportedly cried because of a toothache. CONCLUSIONS: Of significance in this study were the findings that: caries is highly prevalent in this underserved preschool population; pain due to dental caries is not uncommon; and there is little utilization of dental care despite federally mandated and Head Start and Medicaid requirements.

Analysis of Variance↗
PubMedDate not supplied

Use of verbal descriptors, thermal scores and electrical pulp testing as predictors of tooth pain before and after application of benzocaine gels into cavities of teeth with pulpitis.

A double-blind pilot study was conducted on 27 consenting human volunteers who had irreversible pulpitis associated with persistent toothache pain from open carious lesions. Formulations tested contained either 0, 10%, or 20% benzocaine and were identified only by a numbered code. Before the experiment started, a small amount of a known 5% benzocaine gel was placed for 1 minute on the tongue of each patient to assure a sensation of numbness within the oral cavity. Then the test tooth was washed with a gentle stream of warm water and dried with gauze. A randomly selected test medication was placed into the open cavity and around the gingival margins for 5 minutes. Pre- and posttreatment tests were conducted at the following timed intervals: 0, 5, 15, 30, 45, 60, 75 and 90 minutes. The tests included degree of pain (rated: 0 = none, 1 = mild, 2 = moderate, 3 = severe); electrical pulp testing (EPT) by a modified, voltage-ramping instrument; and ice water testing (0.5 mL directed quickly onto sound enamel of the tooth and rated: 0 to 4, with 4 being intolerable). After testing, or when pain returned to baseline, endodontic procedures were performed. There was a significant increase (p < 0.032, Fisher exact test) in subjects obtaining pain relief, rated by verbal descriptors, from the benzocaine gels (14 out of 18 improved) compared to placebo (3 out of 9 improved). It was concluded that: 1) benzocaine gels are effective formulations for temporary relief of toothache pain, 2) there were no statistical differences in EPT scores between teeth having pulpitis and control teeth, 3) there were no correlations between direction of EPT scores and pain relief, 4) cold water testing was a good predictor of whether or not a tooth had pulpitis, and 5) changes in cold water testing scores after treatment could not be correlated to relief of pain according to verbal descriptors. The effectiveness of benzocaine in relieving toothache pain verifies previous studies; however, a difference between 10% and 20% benzocaine could not be demonstrated probably because of two factors: 1) the present experiment had a small sample size, and 2) there was no direct measurement of duration of local anesthesia.

Adult↗
PubMed1989

Correlates of self-reported dental health status upon enrollment in the Rand Health Insurance Experiment.

This study explored the personal impact of dental problems in terms of pain, worry, and conversation avoidance, and factors associated with this impact. A self-reported dental health index, comprising three questions asked of participants in the Rand Health Insurance Experiment, was examined. Index reliability was 0.69. One-way analysis of variance and Pearson's product-moment correlations were used to explore the bivariate associations between the index and sociodemographic variables, provider-assessed clinical indicators, and the respondent's report of a toothache. Perceived dental health of the study sample (N = 1,658) was notably lower in the presence of a toothache, increasing numbers of decayed teeth, and worsening periodontal health. Weaker, but statistically significant, associations were observed for sociodemographic factors. Nonwhites and those persons with lower educational and income levels reported more impact. In regression analysis, standardized coefficients indicated that the respondent's report of a toothache and, secondarily, numbers of decayed teeth were the most important explanatory factors. These findings suggest that in the future improved self-reported measures, in addition to clinical indicators, may be an acceptable and cost-effective method of epidemiological data collection and dental health outcome assessment.

Adolescent↗