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PubMed2006

Determining toothache severity in pediatric patients: A study.

To correlate sodium-potassium levels in saliva of pediatric patients having different intensities of toothache assessed by Visual Analogue Scale (VAS) in age group 3-14 yrs. A prospective study of 50 children having different intensities of pain was carried out in the Dept. of Pedodontics, Sareetha Dental College and Hospital. 50 children (aged 3-14 yrs) having different intensities of toothache including normal children (control) were included in the study. Saliva samples were collected and Na+, K+ levels in saliva were measured by using Na+, k+ colorimeter kit. Photographs were taken using Digital camera and VAS was prepared accordingly. Sodium levels decreased with increasing pain intensity and potassium levels increased, facial expressions correlated with Na+, K+ levels. Correlation between Na+, K+ levels and pain intensity exists. Also, VAS is a valid measure for pain.

Adolescent↗
PubMed2003

Efficacy and tolerability of an intraoral benzocaine patch in the relief of spontaneous toothache pain.

OBJECTIVE: In this randomized, double-blind, placebo-controlled clinical trial, the effectiveness and tolerability of a novel intraoral benzocaine patch was evaluated in 60 patients who presented to the Dental School's emergency clinic with spontaneous toothache pain of at least a moderate intensity. METHODOLOGY: Mucoadhesive patches, containing either 12 mg of benzocaine or a matching placebo, were applied approximately two millimeters apical to the mucogingival junction of the symptomatic tooth and remained in place for 60 minutes. Pain intensity (0-4 scale) and pain relief (0-4 scale) were recorded every five minutes through 30 minutes, and then every ten minutes through the 90-minute time point. The onset times of first perceptible and meaningful relief were recorded using two stopwatches. The occurrence of adverse events was also monitored. RESULTS: While the benzocaine patches were numerically superior to the placebo patches at all time points with respect to pain relief, PID (pain intensity difference) and their summed measures (TOTPAR and SPID scores), an analysis of covariance revealed no significant differences between treatments. Survival analysis indicated that the percentage of patients reporting meaningful pain relief by 30 minutes was significantly (p < 0.05) greater in the benzocaine group than in the placebo group (77% for benzocaine and 47% for placebo). The median onset times to first perceptible and meaningful relief were 5.4 and 18.1 minutes in the benzocaine group, and 7.8 and 30.4 minutes in the placebo group. Only two side effects (headache) were reported in the entire study. CONCLUSION: Although the results of the present study were promising, further research on this novel delivery system of benzocaine is warranted to firmly establish efficacy in patients with spontaneous toothache pain.

Administration, Oral↗
PubMedDate not supplied

Evaluation of toothache severity in children using a visual analogue scale of faces.

PURPOSE: Pain is a frequent symptom of oral disease. It is difficult to measure, however, due to its subjectivity, especially among children. The purpose of this study was to verify the utility and applicability of a visual analogue scale of faces (VASOF), adapted for 8- to 9-year-olds, to measure the severity of toothaches. METHODS: A cross-sectional study was undertaken, which included 601 boys and girls randomly selected from state and private schools in the city of Belo Horizonte, Minas Gerais, Brazil. They were interviewed and clinically examined, and a VASOF was applied. RESULTS: The VASOF's application revealed a high percentage of intense/very intense pain in the sample (39%). The presence of this pain intensity was accompanied by a high incidence of children who cried, were awakened by the pain, and were unable to carry out habitual tasks. Furthermore, this severe pain was strongly associated with less-privileged economic groups and the presence of oral pathology (P< or =.05). The scale was well understood by children, independent of gender or economic group. CONCLUSIONS: A VASOF was found to be capable of measuring toothache severity experienced by school-age children.

Activities of Daily Living↗
PubMed2005

A study of benzocaine gel dosing for toothache.

OBJECTIVE: This pilot study evaluated subject compliance with a proposed OTC label with improved dosing directions for self-application of a 20% benzocaine gel for toothache pain, and assessed the methodology for evaluating efficacy in a future pivotal study of benzocaine gel. It was hypothesized that > or = 75% of subjects would apply < or = 400 mg of product (80 mg benzocaine). Exploratory analyses of efficacy were also performed. METHODOLOGY: Thirty patients with spontaneous pain of moderate or severe intensity from a single tooth due to caries, a lost restoration, or a fracture entered this randomized, parallel group, double-blind study. Before self-applying 20% benzocaine gel or placebo, patients read a label containing new dosing directions, including a picture of how much product to apply to their tooth and the surrounding gingival tissues. The amount applied was determined by weighing the tube before and after dosing. Following dosing, pain intensity and relief were recorded every five minutes through 30 minutes, then every ten minutes through 120 minutes. Responders were defined as those subjects who experienced at least a one-unit reduction in pain intensity from baseline at two consecutive time points within the first 20 minutes. Onset of meaningful relief was recorded using a stopwatch. The percentage of responders was compared using the Mantel-Haenszel test. ANOVA was employed to test for differences in Pain Relief Combined with Pain Intensity Difference (PRID), and the areas under the curve at 30, 60, 90, and 120 minutes for this measure (SPRID). Median onset and duration times were compared using the Cox proportional hazards model. Adverse events were recorded if and when they occurred. RESULTS: It was found that 86.7% of the subjects (26/30) applied < or = 375 mg of product (mean +/- SD = 327.7 +/- 276.8 mg). The benzocaine group had a significantly higher (p = 0.022) responder rate (86.7%) than the placebo group (46.7%). Significant differences in favor of the benzocaine group were also recorded for PRID at 10, 15, and 30 minutes (p < 0.05) and SPRID-30 (p = 0.037). Median onset and duration times were 8.3 minutes and > 115 minutes for the benzocaine group, >120 minutes and 5 minutes for the placebo group. There were no adverse events recorded in the study. CONCLUSION: The improved dosing directions resulted in a high percentage of subjects self-applying an appropriate amount of benzocaine gel or matching placebo. The label and study methodology appear suitable for a pivotal dose-response study in subjects with toothache pain. While the current study was not statistically powered to make firm efficacy conclusions, 20% benzocaine gel appeared more efficacious than placebo, providing a rapid onset of pain relief and a relatively long duration of action.

Adolescent↗
PubMed1991

Headache problems that can present as toothache.

Toothache of nonodontogenic origin may be better differentiated with the use of differential diagnostic blockade. Table 9 reviews the expected outcome of somatic block at the site of pain and when the nerve division or the site of nociception is blocked. Although there is considerable overlap, this technique together with a careful history and detailed physical examination will prevent many unnecessary irreversible treatments. If no sign of periapical pathology can be determined (radiography is normal) and the dental examination is nonrevealing, at least a 4-month period should be allowed to elapse before considering any irreversible dental procedure. During this time pharmacologic trials may be attempted, bearing in mind the clinical presentation. Patients should be informed that it may take at least 4 months for the dental pathology to manifest and in the hope of preventing irreversible damage, careful observation accompanied by the pharmacologic trials will be carried out. The practicing clinician is encouraged to maintain a broad perspective of the differential diagnosis of toothache when the pathology is not obvious.

Diagnosis, Differential↗
PubMed1994

The role of traditional healers in the treatment of toothache in Tanga Region, Tanzania.

The study was conducted in five villages in each of two districts in the Tanga Region of Tanzania. Seventy-three traditional healers and 408 villagers of 14 years and above (selected through systematic random sampling) were interviewed. Most of the traditional healers had practised for more than ten years and the majority had been trained by their father or grandfather. Sixty per cent of the traditional healers claimed, that they treated dental patients with an average of three patients per month. A large variety of local herbs was used and about 40 per cent of the traditional healers claimed that they would refer the client to a modern health facility, if their treatment did not work. Half of the villagers interviewed had experienced toothache and 60 per cent of those who had experienced toothache within the last two years had sought treatment from traditional healers, where they had all been treated with local herbs. Relief was obtained for more than six months for 40 per cent of the patients, who sought this service. The establishment of modern emergency oral care in rural health centres and dispensaries did not influence the villagers' use of the traditional healers.

Adolescent↗
PubMed2002

Temporal arteritis: a cough, toothache, and tongue infarction.

Temporal arteritis, the most common form of systemic vasculitis in adults, is a panarteritis that chiefly involves the extracranial branches of the carotid artery. The condition is illustrated in this article by the case of a 79-year-old woman with a dry cough, toothache, tongue infarction, and vision loss. The mean age of onset is 72 years and the disease rarely occurs in persons younger than 50 years. The most common presenting manifestations are headache, jaw claudication, polymyalgia rheumatica, and visual symptoms. Eighty-nine percent of patients have an erythrocyte sedimentation rate greater than 50 mm/h. However, about 40% of patients present with atypical manifestations, including fever of unknown origin, respiratory tract symptoms (especially dry cough), and large artery involvement. Familiarity with such unusual manifestations of temporal arteritis facilitates early diagnosis and treatment, thereby reducing the risk of vision loss.

Aged↗
PubMed2002

Toothache tales: Part 1.

This selection of literary extracts deals with the subject of toothache from the point of view of the sufferer. Circumstances, effects and remedies, orthodox and otherwise, are described.

Adult↗
PubMed2005

Myofascial pain and toothaches.

Despite improved understanding of orofacial pain in recent years, accurate diagnosis of pain is still challenging in modern dentistry. Many disorders in the head and neck region are known to refer pain to dental structures and imitate dental pain. Due to the location of the perceived pain dental clinicians are often involved in the diagnosis and management of the pain. Myofascial pain (MFP) is widely believed to be the most frequently occurring orofacial pain of non-odontogenic origin. It has long been known that MFP could mimic pulpitic symptoms. Past studies have shown that MFP is a relatively prevalent condition among the general population and the one that is most often misdiagnosed by dentists. Despite its prevalence and the potential for misdiagnosis, there has been little investigation into this old problem, and information about myofascial pain remains fragmented and poorly understood. In this article some of the features associated with myofascial pain will be highlighted. The inter-relationship between myofascial pain and toothaches will also be examined and suggestions made in the areas of diagnosis and management of the condition. It is hoped that dental clinicians will be able to differentiate and manage the conditions effectively when dealing with them in the future.

Diagnosis, Differential↗
PubMed1999

Toothache of cardiac origin.

Pain referred to the orofacial structures can sometimes be a diagnostic challenge for the clinician. In some instances, a patient may complain of tooth pain that is completely unrelated to any dental source. This poses a diagnostic and therapeutic problem for the dentist. Cardiac pain most commonly radiates to the left arm, shoulder, neck, and face. In rare instances, angina pectoris may present as dental pain. When this occurs, an improper diagnosis frequently leads to unnecessary dental treatment or, more significantly, a delay of proper treatment. This delay may result in the patient experiencing an acute myocardial infarction. It is the dentist's responsibility to establish a proper diagnosis so that the treatment will be directed toward the source of pain and not to the site of pain. This article reviews the literature concerning referred pain of cardiac origin and presents a case report of toothache of cardiac origin.

Angina Pectoris↗
PubMed2003

'Toothache stories': a qualitative investigation of why and how people seek emergency dental care.

OBJECTIVE: To understand from the patient's perspective the types of dental problem which present at weekends, how they affect people, and the care-seeking behaviour of emergency dental patients. BASIC DESIGN: Consecutive patients attending two emergency dental clinics at weekends were interviewed prior to seeing the dentist. The audio-recorded interview transcripts were analysed using the "framework" method of applied qualitative data analysis. SETTING: A community-based and a dental hospital emergency dental clinic. SUBJECTS: 44 emergency dental patients. RESULTS: Pain was the main presenting symptom, a key domain of quality of life and the underlying cause of most other quality of life effects. However, for patients deciding what symptoms mean--crucially whether they mean they need to see a dentist urgently--a wide range of other contextual factors come into play. These go beyond the individual patient's recent and current perception of symptom intensity. They encompass past experience of similar symptoms, past care-seeking experiences, anticipated effects on quality of life, anticipated service availability, joint decision-making and lay information from family and friends, professional opinions from non-dentists, expectations concerning what work dentists should do, and what symptoms distinguish "simple toothache" from more serious problems. CONCLUSIONS: The effects of, and meanings which people attach to, acute dental symptoms are complex. Combined with poor awareness of the existence of emergency dental services it is not surprising that patients' pathways to care are correspondingly complicated. The planning of emergency dental services should be based on a broader, patient-derived understanding of the need for them.

Adolescent↗
PubMed2004

Malignant fibrous histiocytoma of the maxillary sinus presenting as toothache.

Malignant fibrous histiocytoma (MFH) is a high-grade and aggressive sarcoma. It is relatively rare in the head and neck region. Its diagnosis is based on immunohistochemical stains. Wide excision followed by postoperative radiotherapy is believed to be the treatment of choice for MFH. In October 2001, a case of MFH in the maxillary sinus, which presented as a toothache at the beginning, was successfully diagnosed and treated. Using the external approach, the tumor mass was completely removed, and postoperative radiotherapy was subsequently performed. Seventeen months after the surgery, the patient was clinically well without any evidence of local recurrence or distant metastasis.

Adult↗
PubMed1991

[Acute and chronic toothache].

Toothache occurs as a result of pulpal and periodontal diseases. Due to the nature of their innervation pain is the only means for both pulp and dentine to react to all kinds of external stimuli. The actual mechanism of sensory transmission, however, has not been clarified, yet. In contrast to this, the innervation of the periodontium offers a wide range of mechano-sensitive receptors. Chronic dental pain is mainly the result of inflammatory reactions. Nerve sprouting, summation, convergence in the trigeminal system and regional inflammatory conditions modulate the local pain process, thus complicating diagnosis. The differential diagnostic clarification with regard to neuralgiform and ENT-diseases therefore requires special care with case history and status. Although there have been advances in pain research over the last few years, no fundamental development in dental diagnosis has been brought about, yet. Probing, sensitivity- and percussion testing as well as x-ray exposure are still the most important diagnostic tools for the dental practitioner.

Acute Disease↗
PubMed1981

Facial pain - toothache or tumour?

Three cases are presented which illustrate the diagnostic problem of vague facial pain. One patient complained of toothache and was finally proved to have an intraventricular meningioma. The second had been diagnosed as trigeminal neuralgia but was finally found to have a meningioma. The third presented with facial pain, underwent 2 weeks of intensive neurological investigations and the pain was finally related to pulpitis in an upper molar. These three cases serve to stimulate a discussion on the problems of diagnosis of facial pain and the role of computerised axial tomography in this field.

Adult↗
PubMed1993

Chronic paroxysmal hemicrania presenting as toothache.

Chronic paroxysmal hemicrania is an intermittent head-pain problem that is characterized by pain paroxysms lasting about 15 minutes. The attacks usually produce pain in the frontotemporal region and are responsive to indomethacin. A set of symptoms that defines chronic paroxysmal hemicrania is presented, and two cases in which the presenting symptom was toothache are reported. It is emphasized that clinicians should consider chronic paroxysmal hemicrania in the differential diagnosis of orofacial pain.

Aged↗
PubMed2002

Toothache tales: Part 2.

The second part of the selection of literary excerpts on toothache deals with extraction as the ultimate curse. In common with killing a cat, there are many ways to do it.

Female↗