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PubMed2003

Early clinical results from the use of 5% potassium nitrate in polycarboxylate cement for biological treatment of reversible pulpitis.

UNLABELLED: The aim of the present study was to obtain immediate and early clinical results from the use of 5% potassium nitrate (KNO3) in polycarboxylate cement for biological treatment of reversible pulpitis. MATERIAL AND METHODS: The method was applied in 140 teeth, mostly premolars and molars, with a clinical diagnosis of reversible pulpitis and indications for biological treatment of the inflamed dental pulp by means of indirect pulp capping. All teeth had clinically healthy periodontium and no non-carious lesions of the hard dental tissues. The study sample consisted of 127 patients aged between 16 and 40 years. The control group included 92 teeth in 78 patients, which were treated by a calcium hydroxide liner. The follow-up examinations were conducted 24 hours after treatment and on day 3 for the immediate results, and on days 7, 14, 30, and 90 for the early clinical results assessing the functional condition of the teeth, presence of thermal stimulus-induced pain and the measurements from the electric pulp vitality tests. The results were analysed with the analysis of variance and graphic analysis. RESULTS: The immediate and early clinical results of the biological treatment of reversible pulpitis with 5% KNO3 in polycarboxylate cement show that pain as a symptom of the initial inflammatory process in the dental pulp is rapidly and effectively relieved, leaving the treated teeth in good functional condition. The comparison of the measurements from the electric pulp tests of all teeth reveals a statistically significant difference (u = 8.51; P < 0.001) in favour of the group treated with potassium nitrate and polycarboxylate cement. CONCLUSIONS: 1. The immediate and early clinical results of our study suggest that treating reversible pulpitis with 5% KNO3 in polycarboxylate cement has an a very good analgesic action 2. The normal electrical excitability of the treated teeth is restored faster than that in the teeth treated by calcium hydroxide-based materials (P < 0.001).

Adolescent↗
PubMed1991

[Study on the diagnosis of the deciduous tooth pulpitis by the blood picture in the dental pulp].

The purpose of this study was to investigate the method of diagnosis of deciduous tooth pulpitis to make sure of the extent of the inflammation for more appropriate pulp therapy. The subjects were 100 decayed deciduous teeth of the 81 normal healthy children aged from 2y9m to 11y2m, which justified the vital pulp amputation therapy according to Nagasaka's deciduous tooth pulpitis diagnosis criteria. The blood picture was compared with the histological structure of the coronal pulp and then observed after treatment. The diagnosis of the deciduous tooth pulpitis was considered by the blood picture in the dental pulp. The results were as follows. 1. As to the blood picture in the deciduous dental pulp, it was suggested that the lymphocyte ratio was able to be taken for the discrimination of the deciduous tooth pulpitis, because ratio of lymphocyte in the coronal pulp was higher than its normal values in the peripheral blood picture regardless of the age. 2. As to the histological structure of the removed coronal pulp, the inflammatory degree was divided into 4 types; (-) no evidence of inflammation, (+) slightly confined infiltration of the inflammatory cells, (++) slightly or moderately diffused infiltration, ( ) severely diffused infiltration, when the numbers of the case at each degree type were (-) 0, (+) 37, (++) 47 and ( ) 16 cases. 3. As to the ratio of the lymphocyte ratio over 60% against all at each degree type, (+) 86.5% and (++) 61.7% were much higher than ( ) 0%. 4. The ratio of cases in which it was difficult to control bleeding at ratios of the coronal pulp amputations were type (+) 32.4% and (++) 25.5% in type, however, type ( ) showed high rate (62.5%). 5. As a result of the clinical and X-ray examination after vital pulp amputation therapy, the number of poor case was 12 of 42 cases (28.6%) in type (+) (++) and 4 of 4 cases (100%) in type ( ). 6. This result suggests that the vital pulp amputation therapy is not adequate when it is hard to control bleeding and the lymphocyte ratio of blood picture in the coronal pulp shows under 57%.

Child↗
PubMedDate not supplied

[Thermometric diagnostics of chronic ulcerous pulpitis].

Thermometric measurements were performed of 408 teeth of the upper and lower jaw with clinically confirmed initial and advanced stage of chronic ulcerous pulpitis in 398 subjects, aged from 18 to 30. Temperature elevation within the range from 1.4 to 3.2 degrees C was established in the initial form of chronic pulpitis and from 1 to 2.5 degrees C in advanced form of chronic pulpitis as compared with the norm. Significant difference in the temperature deviations exists in both forms of chronic pulpitis between the teeth of the upper and lower jaw.

Adult↗
PubMed2006

A Cochrane systematic review finds no evidence to support the use of antibiotics for pain relief in irreversible pulpitis.

The Cochrane Systematic Review promotes evidence-based outcomes studies. The review summarized here was conducted in an attempt to achieve reliable evidence concerning the effectiveness, or otherwise, of prescribing antibiotics for patients having irreversible pulpitis. A competent search strategy was developed and used across several databases including MEDLINE to identify randomized controlled trials for inclusion. Assessment of methodological quality was based on criteria defined by The Cochrane Collaboration. Clinical outcome, expressed in terms of pain relief, was examined. There was a relative dearth of research providing a high level of evidence. Only one methodologically sound trial was found that compared pain relief with systemic antibiotic/analgesic treatment against a placebo/analgesic combination during the acute preoperative phase of irreversible pulpitis. Although the selected study used a relatively small, low-powered sample, it did provide some evidence that there is no significant difference in pain relief for patients with untreated irreversible pulpitis who received antibiotics versus those who did not. These findings increase the rationale to investigate the teaching of safe and effective antibiotic prescribing in endodontics and to advance the development of appropriate evidence-based clinical guidelines.

Adult↗
PubMed2006

Articaine for supplemental intraosseous anesthesia in patients with irreversible pulpitis.

The purpose of this study was to determine the anesthetic efficacy and heart rate effect of 4% articaine with 1:100,000 epinephrine for supplemental intraosseous injection in mandibular posterior teeth diagnosed with irreversible pulpitis. Thirty-seven emergency patients, diagnosed with irreversible pulpitis of a mandibular posterior tooth, received an inferior alveolar nerve block and had moderate-to-severe pain upon endodontic access. The Stabident system was used to administer 1.8 ml of 4% articaine with 1:100,000 epinephrine. Success of the intraosseous injection was defined as none or mild pain upon endodontic access or initial instrumentation. The results demonstrated that anesthetic success was obtained in 86% (32 of 37) of the patients. Maximum mean heart rate was increased 32 beats/minute during the intraosseous injection. We can conclude that when the inferior alveolar nerve block fails to provide profound pulpal anesthesia, the intraosseous injection of 4% articaine with 1:100,000 epinephrine would be successful 86% of the time in achieving pulpal anesthesia in mandibular posterior teeth of patients presenting with irreversible pulpitis.

Adolescent↗
PubMed2007

Anesthetic efficacy of lidocaine/meperidine for inferior alveolar nerve blocks in patients with irreversible pulpitis.

The purpose of this prospective, randomized, single-blind study was to compare the anesthetic efficacy of lidocaine with epinephrine to lidocaine plus meperidine with epinephrine for inferior alveolar nerve blocks (IAN) in patients with mandibular posterior teeth experiencing irreversible pulpitis. Forty-eight emergency patients diagnosed with irreversible pulpitis of a mandibular posterior tooth randomly received, in a single-blind manner, 36 mg of lidocaine with 18 mug epinephrine or 36 mg of lidocaine with 18 mug of epinephrine plus 36 mg meperidine with 18 mug epinephrine, using a conventional inferior alveolar nerve block. Endodontic access was begun 15 minutes after solution deposition, and all patients were required to have profound lip numbness. Success was defined as no or mild pain (visual analog scale recordings) upon endodontic access or initial instrumentation. The success rate for the inferior alveolar nerve block using the lidocaine solution was 26%, and for the lidocaine/meperidine solution, the success rate was 12%. There was no significant difference (p = 0.28) between the two solutions. In conclusion, for mandibular posterior teeth with irreversible pulpitis, the addition of 36 mg of meperidine to a lidocaine solution administered in a conventional IAN block did not improve the success rate over a standard lidocaine solution.

Adjuvants, Anesthesia↗
PubMed1998

Anesthetic efficacy of the supplemental intraosseous injection of 2% lidocaine with 1:100,000 epinephrine in irreversible pulpitis.

The purpose of this study was to determine the anesthetic efficacy of a supplemental intraosseous injection of 2% lidocaine with 1:100,000 epinephrine in teeth diagnosed with irreversible pulpitis. Fifty-one patients with symptomatic, vital maxillary, and mandibular posterior teeth diagnosed with irreversible pulpitis received conventional infiltrations or inferior alveolar nerve blocks. Pulp testing was used to determine pulpal anesthesia after "clinically successful" injections. Patients who were positive to the pulp tests, or were negative to the pulp tests but felt pain during endodontic access, received an intraosseous injection using 1.8 ml of 2% lidocaine with 1:100,000 epinephrine. The results demonstrated that 42% of the patients who tested negative to the pulp tests reported pain during treatment and required supplemental anesthesia. Eighty-one percent of the mandibular teeth and 12% of maxillary teeth required an intraosseous injection due to failure to gain pulpal anesthesia. Overall, the Stabident intraosseous injection was found to be 88% successful in gaining total pulpal anesthesia for endodontic therapy. We concluded that, for posterior teeth diagnosed with irreversible pulpitis, the supplemental intraosseous injection of 2% lidocaine (1:100,000 epinephrine) was successful when conventional techniques failed.

Adult↗
PubMed1997

Anesthetic efficacy of the supplemental intraosseous injection of 3% mepivacaine in irreversible pulpitis.

OBJECTIVE: To determine the efficacy of a supplemental intraosseous injection of 3% mepivacaine in mandibular posterior teeth with irreversible pulpitis. Intraosseous injection pain, subjective heart rate increase, and pain ratings during endodontic treatment were also assessed. STUDY DESIGN: Forty-eight patients with irreversible pulpitis received conventional inferior alveolar nerve blocks. Electric pulp testing was used to determine pulpal anesthesia. Patients who were positive to the pulp testing, or negative to pulp testing but felt pain during endodontic treatment, received an intraosseous injection of 1.8 ml of 3% mepivacaine. A second intraosseous injection of 3% mepivacaine (1.8 ml) was given if the first injection was unsuccessful. RESULTS: Seventy-five percent of patients required an initial intraosseous injection because of failure to gain pulpal anesthesia. The inferior alveolar block was 25% successful; the first intraosseous injection increased success to 80%. A second intraosseous injection further increased success to 98%. These differences were significant (p < 0.05). Eight percent (4/48) of the initial intraosseous injections resulted in solution being expressed into the oral cavity: these were considered technique failures. CONCLUSIONS: For mandibular posterior teeth with irreversible pulpitis, a supplemental intraosseous injection of 3% mepivacaine increased anesthetic success. A second intraosseous injection, when necessary, further improved success.

Adolescent↗
PubMed2006

Nitric oxide levels in serum of patients with symptomatic irreversible pulpitis.

Nitric oxide (NO) affects both pain and inflammation in human tissues. Pharmacotherapy that decreases NO concentrations may have utility in treating inflammatory painful conditions. To determine the types of disorders in which such an approach should be studied, changes in NO serum levels before and after the painful inflammatory condition resolves would be helpful. This study compared the pre-treatment and post-treatment serum nitric oxide (NO) concentrations in irreversible pulpitis (inflammatory toothache). Thirty-two patients (16 males, 16 females) with irreversible pulpitis were included in this study. Before treatment, patients had severe symptoms of inflammation, but at the end of treatment no symptoms of inflammation were observed. NO concentrations were measured in serum of patients with irreversible pulpitis, before and after treatment. Differences in serum NO concentrations were not statistically significantly different before and after treatment.

Adolescent↗
PubMed2000

Pain reduction in untreated irreversible pulpitis using an intraosseous injection of Depo-Medrol.

The purpose of this prospective, double-blind, randomized study was to evaluate pain reduction using an intraosseous injection of slow-releasing methylprednisolone in teeth with irreversible pulpitis. Forty subjects presenting for emergency treatment completed the study. Each subject had a tooth with a clinical diagnosis of irreversible pulpitis with actively associated moderate to severe pain. After local anesthesia was attained, the subjects were randomly assigned to receive an intraosseous injection of either 1.0 ml of Depo-Medrol (40 mg) or 1.0 ml of sterile saline (control). No endodontic therapy was begun at the initial appointment. The subjects received ibuprofen and Tylenol #3 and completed a 7-day questionnaire on pain, percussion pain, and analgesic medications taken each day. Over the 7-day observation period, the subjects who received the intraosseous injection of Depo-Medrol reported significantly (p < 0.05) less pain and percussion pain while taking significantly (p < 0.05) fewer pain medications. Clinically the intraosseous injection of Depo-Medrol could be used to temporarily alleviate the symptoms of irreversible pulpitis until definitive treatment can be rendered.

Acetaminophen↗
PubMed2003

The significance of needle deflection in success of the inferior alveolar nerve block in patients with irreversible pulpitis.

The purpose of this prospective, randomized, blinded study was to compare the anesthetic efficacy of the conventional inferior alveolar nerve block, administered with the needle bevel oriented away from the mandibular ramus, to the bidirectional-needle-rotation technique, administered using the computer-assisted Wand II anesthesia system, in patients diagnosed with irreversible pulpitis. Sixty-four emergency patients diagnosed with irreversible pulpitis of a mandibular posterior tooth randomly received, in a blinded manner, 2.8 ml of 2% lidocaine with 1:100,000 epinephrine using either a conventional inferior alveolar nerve block or a bidirectional-needle-rotational technique using the Wand II injection system. The conventional inferior alveolar nerve block was administered with the needle bevel oriented away from the mandibular ramus so the needle would deflect inward toward the mandibular foramen. The bidirectional-needle-rotation technique was administered by rotating the Wand handpiece assembly in a clockwise-counterclockwise movement (like an endodontic hand file) to minimize needle deflection. Endodontic access was begun 17 min after solution deposition, and all patients were required to have profound lip numbness. Success was defined as none or mild pain (VAS recordings) on endodontic access or initial instrumentation. The results of this study showed no significant differences (p > 0.05) between the success rates of the two techniques. The conventional inferior alveolar nerve block, with the needle bevel oriented away from the mandibular ramus, had a 50% success rate. The bidirectional-needle-rotation technique with the Wand II had a 56% success rate. Neither technique resulted in an acceptable rate of anesthetic success in patients with irreversible pulpitis.

Adult↗
PubMed2003

Anesthetic efficacy of the supplemental X-tip intraosseous injection in patients with irreversible pulpitis.

The purpose of this study was to determine the anesthetic efficacy of the supplemental intraosseous injection, using the X-tip system in an apical location, in mandibular posterior teeth diagnosed with irreversible pulpitis when the conventional inferior alveolar nerve block failed. Thirty-three emergency patients, diagnosed with irreversible pulpitis of a mandibular posterior tooth, received an inferior alveolar nerve block and had moderate-to-severe pain on endodontic access. The X-tip system was used to administer 1.8 ml of 2% lidocaine with 1:100,000 epinephrine. The X-tip injection site was 3- to 7-mm apical to the mucogingival junction of the affected tooth. Success of the X-tip intraosseous injection was defined as none or mild pain on endodontic access or initial instrumentation. The results of this study demonstrated that 6 of 33 (18%) X-tip injections resulted in backflow of anesthetic solution into the oral cavity; none were successful in obtaining anesthesia. Twenty-seven of the remaining 33 X-tip injections (82%) were successful. We conclude that when the inferior alveolar nerve block fails to provide profound pulpal anesthesia, the X-tip system, when used in an apical location and when there was no backflow of the anesthetic solution into the oral cavity, was successful in achieving pulpal anesthesia in mandibular posterior teeth of patients presenting with irreversible pulpitis.

Adult↗
PubMed2004

Expression of calcitonin gene-related peptide (CGRP) in irreversible acute pulpitis.

The main goal of this study was to evaluate tissue levels of calcitonin gene-related peptide (CGRP) in human pulpal samples collected from teeth with a clinical diagnosis of acute irreversible pulpitis, normal pulps, and teeth with induced pulpal inflammation. All the pulp tissue was mechanically separated, collagenase digested to release individual cells, and labeled with FITC detection of an anti-CGRP polyclonal antibody. Detection of CGRP was possible in these cells due to a binding of the antibody to CGRP that was itself bound to its cell surface receptor. Flow cytometry analysis indicated that the labeled pulp cells were located in a region of low size and complexity according to their forward (FSC) and side scatter (SSC) properties. Significant statistical differences were found between the percentages of CGRP expression in healthy pulps and pulps with induced inflammation and between healthy pulps and pulps with acute irreversible pulpitis. No significant statistical differences were found between pulps with induced inflammation and pulps with acute irreversible pulpitis. These findings support the hypothesis that the CGRP system is active in human pulpal inflammation and may modulate the inflammatory response.

Adult↗
PubMed2004

Anesthetic efficacy of articaine for inferior alveolar nerve blocks in patients with irreversible pulpitis.

The purpose of this prospective, randomized, double-blind study was to compare the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine to 2% lidocaine with 1:100,000 epinephrine for inferior alveolar nerve blocks in patients experiencing irreversible pulpitis in mandibular posterior teeth. Seventy-two emergency patients diagnosed with irreversible pulpitis of a mandibular posterior tooth randomly received, in a double-blind manner, 2.2 ml of 4% articaine with 1:100,000 epinephrine or 2.2 ml of 2% lidocaine with 1:100,000 epinephrine using a conventional inferior alveolar nerve block. Endodontic access was begun 15 min after solution deposition, and all patients were required to have profound lip numbness. Success was defined as none or mild pain (Visual Analogue Scale recordings) on endodontic access or initial instrumentation. The success rate for the inferior alveolar nerve block using articaine was 24% and for the lidocaine solution success was 23%. There was no significant difference (p = 0.89) between the articaine and lidocaine solutions. Neither solution resulted in an acceptable rate of anesthetic success in patients with irreversible pulpitis.

Adult↗
PubMed2005

Anesthetic effectiveness of the supplemental intraligamentary injection, administered with a computer-controlled local anesthetic delivery system, in patients with irreversible pulpitis.

The purpose of this study was to determine the anesthetic effectiveness of the supplemental intraligamentary injection, administered with a computer-controlled local anesthetic delivery system, in mandibular posterior teeth diagnosed with irreversible pulpitis when the conventional inferior alveolar nerve block failed. Fifty-four emergency patients, diagnosed with irreversible pulpitis of a mandibular posterior tooth, received an inferior alveolar nerve block and had moderate to severe pain upon endodontic access. A computer-controlled local anesthetic delivery system was then used to administer intraligamentary injections of 1.4 ml of 2% lidocaine with 1:100,000 epinephrine. Success of the intraligamentary injection was defined as none or mild pain upon endodontic access or initial instrumentation. The results demonstrated that anesthetic success was obtained in 56% (30 of 54) of the patients. We concluded that when the inferior alveolar nerve block failed to provide profound pulpal anesthesia in mandibular posterior teeth of patients presenting with irreversible pulpitis, the intraligamentary injection administered with a computer-controlled local anesthetic delivery system was successful approximately 56% of the time.

Adult↗
PubMed1993

Partial pulpotomy in crown-fractured permanent incisor with hyperplastic pulpitis: a case report.

Hyperplastic pulpitis, which is regarded as one type of asymptomatic irreversible pulpitis, occurs usually in young teeth where pulps are exposed by caries or trauma. If apices are mature, root canal therapy is recommended. In this case, the success of partial pulpotomy in a crown-fractured permanent incisor with hyperplastic pulpitis, which had been contaminated with oral microflora for six months is reported.

Adolescent↗
PubMed1999

[Relative analysis of the mRNA expression between endothelin and inducible nitric oxide synthase in pulpitis].

OBJECTIVE: To study the relationship between endothelin-1(ET-1) and inducible nitric oxide synthase (iNOS) through the mRNA expression in pulpitis. METHODS: The model of experimental rat pulpitis; extraction of RNA, the reverse-polymerase chain reaction(RT-PCR) were used. RESULTS: The mRNA expression of ET-1/iNOS in pulpitis groups was higher than the control. There was relationship in the mRNA expression between ET-1 and iNOS. CONCLUSION: Pulp microcirculation was mechanized by the contraction and relaxtion of ET-1/iNOS, which could have direct effects on the pathological change. The control mechanism was due to the up-regulation of ET-1/iNOS gene in transcription level.

Animals↗
PubMed2004

[Comparison of the effects of three analgesic therapies on odontalgia caused by pulpitis in molars].

PURPOSE: To compare the effects of analgesic therapies on odontalgia caused by pulpitis in molars by three different methods. METHODS: 173 molars were diagnosed as irreversible pulpitis, and randomized block designed in three groups. Under block or local anesthesia: 46 cases of the first group, leaving teeth on open drainage, after 1 day, sealing devitalized material (arsenic), arranged next appointment 2 weeks later. 52 molars of the second group, enlarging exposure site, drainage several minutes only, sealed devitalized material, re-examined 2 weeks later. 75 cases of the third group, removing roof of pulp chamber, undergoing pulpectomy directly, re-examined 1 week later. Adopting VAS(vital analogue scale) to analyze the pulp receptivity of three different methods and to evaluate the analgesic effects by complete analgesia, effective analgesia, and no response. The data was analysed using chi-square test. RESULTS: The rate of complete analgesia was 50.0%, 63.46% and 76.0%, respectively. There was a significant difference in complete analgesia among the three methods. The analgesic effect of the third group (pulpectomy) was significantly higher than that of the first group (P<0.01).Pulpectomy group had impossibility of adverse effects caused by using devitalizing material (arsenic). CONCLUSIONS: It is worthy to adopt pulpectomy extensively to relieve the pain of molars caused by pulpitis clinically. The course of treatment of the third group was significantly shorter than other groups, and the simultaneous symptoms occurred rarely.

Adult↗