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PubMed2003

Ability of healthy and inflamed human dental pulp to reduce hydrogen peroxide.

This study examined the defensive ability of human dental pulp against H2O2 in healthy and reversible and irreversible pulpitis tissues through determination of catalase activity by spectrophotometric methods. Thirty-five systemically healthy patients were donors of the pulp tissue, and pulp conditions were assessed using clinical and X-ray evaluations. Catalase activity was 1.61 +/- 0.23 U mg(-1) protein in the healthy tissues, 2.99 +/- 0.45 U mg(-1) protein in the reversible pulpitis tissues, and 2.44 +/- 467 mU mg(-1) protein in the irreversible pulpitis tissues. All differences between the groups were statistically significant. These results point to a role for catalase during dental pulp inflammation in humans, and therefore demonstrate an inherent biological defense system against reactive oxidants in human dental pulp.

Adult↗
PubMed2000

Pulpal pain diagnosis--a review.

Evidence gathered from our studies and the work of others appears to support the presence of two distinct nerve pain pathways in the dental pulp, represented by fast conducting A-delta and slow conducting C-fibers. Each of these types of fibers has different pain characteristics: A-delta fibers evoke a rapid, sharp, lancinating pain reaction, and C-fibers cause a slow, dull, crawling pain. Pain response thresholds vary in different regions of the tooth, and thermal, osmotic, ionic, and electric stimuli involve different mechanisms to provoke nerve excitation of the dental pulp. Evidence also points to the fact that the incidence of pain increases as the histopathosis worsens. On interrogation, patients who manifest severe or referred pain almost always give a previous history of pain in the tooth with the ache. Eighty percent of patients who give a previous history of pain manifest histopathologic evidence of chronic partial pulpitis with partial necrosis, the untreatable category, for which endodontics or extraction is indicated. The other 20% exhibit histopathosis of the pulp with slight inflammation to chronic partial pulpitis without necrosis, a treatable category. Clinically, one can determine the degree of pulp histopathosis by asking the patient about a previous history of pain in the involved tooth. This history of previous pain adds another dimension in diagnosis for the clinician as to whether the painful pulpitis is reversible. This information also aids in referred pain localization.

Chronic Disease↗
PubMed1999

[Quantitive study of 6-keto-prostaglandin F1 alpha and thromboxane B2 in human pulp].

OBJECTIVE: To study the change of the levels of 6-keto-prostaglandin F1 alpha (6-K-PGF1 alpha) and thromboxane B2 (TXB2) in deep caries and pulpitis pulp. METHODS: The levels of 6-K-PGF1 alpha and TXB2 were determined by radioimmunoassay (RIA) in 44 pulp tissues from subjects with healthy pulp (H), deep caries (DC), chronic pulpitis (CP) and acute pulpitis(AP). The 6-K-PGF1 alpha/TXB2 ratio(K/T) was calculated. RESULTS: The lconcentrations of 6-K-PGF1 alpha in Group AP were highest and those in Group H were lowest. The levels of TXB2 in Group DC were lower than Group CP and those in Group H were lowest. Significant differences in K/T ratio were found among the groups except those between Group H and DC. The value of Group AP was highest and that of Group CP was lowest. CONCLUSION: The dysbolism and dysequilibrium of PGI2 and TXA2 may be closely related to the genesis of pulp diseases.

6-Ketoprostaglandin F1 alpha↗
PubMed1992

Pulpal vascular changes in inflammation.

Changes in pulpal vessels in experimentally induced acute and chronic pulpitis in dog tooth were investigated using corrosive resin casts and scanning electron microscopic examination. Following a cavity preparation without water spray, increased permeability of blood vessels occurred in the primary stage of acute pulpitis. This was evidenced by the extravasation of resin from the vessel. This phenomenon was found initially in the venular network as well as in the capillary network located under the dentin. The morphological change was minimal in the vascular network underneath the cavity. This is in contrast to an expanded and tortuous vascular network representing an ulceration which was found around an abscess in chronic pulpitis. Furthermore, formation of vascular loops and AVAlc close to the inflamed region may represent a protective change in the pulp against inflammation.

Acute Disease↗
PubMedDate not supplied

Success rates of formocresol pulpotomy and indirect pulp therapy in the treatment of deep dentinal caries in primary teeth.

PURPOSE: This study was performed to retrospectively evaluate treatment of deep caries in primary molars with formocresol pulpotomy (FP) and indirect pulp therapy (IPT). METHODS: 133 primary molars with deep caries approaching the pulp were treated with FP (N = 78) or IPT (N = 55) and followed 2-7 years. All IPTs received immediate stainless steel crowns (SSCs); 61 FPs got an immediate SSC, 13 an intermediate restorative material (IRM), and 4 amalgam. Thirteen IPTs and 25 FPs had pre-operative pain compatible with a diagnosis of reversible pulpitis. Treatment notes and radiographs were independently assessed. RESULTS: Overall IPT success was 93% (51/55) versus 74% (58/78) for FP. Molars with pain compatible with a diagnosis of reversible pulpitis were successfully treated by IPT 85% (11/13) versus 76% (19/25) for FP. FP-treated molars exhibited earlier exfoliation 38% (30/78), while all IPT molars exhibited normal exfoliation. FPs receiving immediate SSCs had 50/61 (82%) succeed; FPs restored with an IRM temporary succeeded 5/13 (39%), amalgam 3/4 (75%). CONCLUSIONS: IPT success was significantly higher than FP (P = 0.01) in the treatment of deep caries. Both IPT and FP were successful in treating teeth with pain compatible with the diagnosis of reversible pulpitis. FP significantly hastened the exfoliation of pulpotomized primary molars (P = 0.001). IPT in primary teeth can be successfully used in a one step procedure. SSCs placed immediately after FP significantly increased FP success vs. FP followed by IRM temporary (P = 0.01).

Chi-Square Distribution↗
PubMed1985

A differential diagnostic approach to the symptomatology of acute dental pain.

Seventy-four patients with acute pulpitis, apical periodontitis, marginal periodontitis, or pulpoperiodontitis were examined. A series of symptoms and signs was registered. Diagnostic specificities and sensitivities were calculated, and thirteen variables were subjected to discriminant analysis and log-linear multiway contingency table analysis. Pulpoperiodonitis was found inseparable from pulpitis on the basis of the registered symptoms and signs. Several symptoms and signs previously believed to have differential diagnostic power were found insignificant. The following combination of symptoms and signs yielded a correct diagnosis in 82.1% of the cases: constant pain, tenderness to temperature changes, "the tooth feels extruded," impaired mouth opening, tenderness to palpation in apical area, and mobility.

Dental Pulp↗
PubMed1985

An evaluation of length and end-phrase of visual analogue scales in dental pain.

Visual analogue scales (VAS) of different lengths (5, 10, 15 and 20 cm) and with different end-phrases (troublesome, miserable, intense, unbearable and worst pain imaginable) were used to record pain in 50 male and 50 female patients with pulpitis or pericoronitis. All 100 patients successfully completed the questionnaire. High correlation was found between the scores on all the scales. Scales of length 10 or 15 cm had the smallest measurement error. The scale with the end-phrase 'worst pain imaginable' was found to be the best choice for comparing present pain or worst pain between different groups. Using this scale no significant difference was found between the scores of males and females or between those of patients with pulpitis and pericoronitis. This study suggests the use of 10 cm visual analogue scales with the end-phrase 'worst pain imaginable' as being the most suitable for measuring dental pain.

Adult↗
PubMed2006

The efficacy comparison of ibuprofen, acetaminophen-codeine, and placebo premedication therapy on the depth of anesthesia during treatment of inflamed teeth.

The purpose of this study was to elucidate whether premedication therapy with acetaminophen-codeine or ibuprofen is able to increase the depth of anesthesia in inflamed teeth. Sixty patients with the diagnosis of irreversible pulpitis in 1 mandibular tooth requiring root canal therapy (RCT) were selected. Two other teeth in the same quadrant were selected as controls. An electric pulp tester (EPT) was used to evaluate pulp sensitivity at the baseline and after drug administration and anesthesia injection. The subjects were divided into 3 groups randomly, and in each group 1 of the 3 drugs including acetaminophen-codeine, ibuprofen, and placebo were administered 1 hour before anesthesia delivery. After 1 hour, anesthesia was injected and after a waiting period, the EPT measurement was recorded. The reversed EPT scale was used to evaluate the depth of anesthesia achieved during RCT. Data were analyzed to statistically compare the results before and after intervention in cases and controls of each group and among different groups. Significanly lower tooth sensitivity levels (TSLs) were observed after intervention in acetaminophen-codeine and ibuprofen groups, which was more significant in the ibuprofen group. The comparison of inflamed teeth TSLs in the acetaminophen-codeine group and the placebo group after anesthesia and drug administration showed significant differences (P = .001). This comparison between ibuprofen and placebo groups also showed significant differences (P approximately 0). Also, significantly lower TSL of inflamed teeth was observed in the ibuprofen group in comparison with the acetaminophen-codeine group (P = .002). This study reflected preoperative administration of ibuprofen, if not contraindicated, as a drug of choice 1 hour before local anesthesia injection as an effective method for achieving a deep anesthesia during RCT of teeth with irreversible pulpitis.

Acetaminophen↗
PubMed1993

Incidence and possible causes of dental pain during simulated high altitude flights.

Of 11,617 personnel participating in simulated high altitude flights up to 43,000 feet, only 30 (0.26%) complained of toothache (barodontalgia). The cause of the barodontalgia in 28 episodes of pain in 25 of these subjects was investigated. Chronic pulpitis was suspected as the cause in 22 cases and maxillary sinusitis in 2. No pathosis was detected in the other four. In 10 cases in which the pulpitis was treated by root filling or replacing a deep filling, subsequent exposure to low pressure caused no pain.

Adult↗
PubMed1998

Stimulation of interleukin-6 production in human dental pulp cells by peptidoglycans from Lactobacillus casei.

Interleukin-6 (IL-6), which is a multifunctional cytokine, has an important role in acute and chronic inflammation. The peptidoglycan (PG) was purified from Lactobacillus casei, which was a Gram-positive bacteria frequently isolated from deep carious lesions and suspected to be a pathogen of pulpitis. In this study, the effects of PG on the production of IL-6 in human dental pulp cells were examined. PG stimulated IL-6 production in a time- and dose-dependent manner. Reverse transcriptase-polymerase chain reaction experiments showed that the increase was dependent on the enhancement of IL-6 mRNA levels. These findings suggest that Gram-positive bacteria, such as L. casei, from carious lesions, might be involved in developing pulpitis through the stimulation of IL-6 production.

Cells, Cultured↗
PubMedDate not supplied

Detection of tumor necrosis factor alpha in normal and inflamed human dental pulps.

BACKGROUND: The aim of this study was to determine concentrations of tumor necrosis factor-alpha (TNF-alpha) in normal, painful, and asymptomatic human dental pulps. METHODS: Pulps were obtained from three groups of teeth, including healthy teeth, asymptomatic teeth with caries and/or large restoration, and symptomatic teeth with clinical diagnosis of irreversible pulpitis. Pulpal tissues were collected, prepared, and analyzed for TNF-alpha concentration by ELISA technique. RESULTS: Nonparametric Kruskal-Wallis test revealed significant differences between TNF-alpha concentration in normal samples (64.01 +/- 53.12 pg/g) and irreversible symptomatic pulpal tissue (1962.99 +/- 1288.75 pg/g), between irreversible symptomatic and asymptomatic (1120.09 +/- 649.72 pg/g), and between normal and irreversible asymptomatic pulpal tissue (p = 0.000). CONCLUSIONS: TNF-alpha may be an objective marker for determining extent of pulpal inflammation associated with irreversible pulpitis.

Biomarkers↗
PubMed2002

Trigeminal c-Fos expression and behavioral responses to pulpal inflammation in ferrets.

Injury to peripheral dental tissues evokes dynamic alternations in central sensory pathways. We have previously reported that transient stimulation of the dental pulp with noxious heat evokes the induction of the immediate early gene product Fos in the transitional region between subnucleus interpolaris and caudalis (Vi/Vc) and subnucleus caudalis (Vc). A question arises as to whether similar changes occur in response to inflammation to the tooth pulp. In this study, the effects of pulpal inflammation produced by bacterial lipopolysaccharide (LPS) on face-grooming behavior and trigeminal Fos expression were examined. Face-grooming behaviors were recorded daily for 3 days pre- and 24, 48 and 72 h post- LPS or saline application. All animals were perfused 72 h post- LPS or saline application. Brainstems were processed for Fos-like immunoreactivity (Fos-LI). Teeth were processed for H&E staining. Histological examination of LPS-treated teeth revealed features of an acute pulpitis. Moreover, LPS-treated animals showed greater face-grooming activity (i.e. tongue protrusions) directed to the injured tooth than the sham-operated group. The number of Fos-positive neurons was greater in the trigeminal subnucleus caudalis (Vc) and the transitional regions (Vi/Vc) in LPS-treated animals compared with sham-operated animals, and greater in the deeper laminae than the superficial laminae of each trigeminal region. LPS treatment did not evoke Fos expression in the rostral trigeminal regions above Vi/Vc. These results demonstrate that LPS-induced pulpal inflammation results in significant alterations in the Vi/Vc and Vc, and such changes may underlie the observed nociceptive behavioral responses and may play an important role in producing a symptomatic pulpitis in humans.

Animals↗
PubMed1999

Increased interleukin-8 expression in inflamed human dental pulps.

OBJECTIVE: Elevated levels of interleukin-8, a potent chemoattractant and activator of neutrophils, are associated with infectious and inflammatory diseases. However, little is known about interleukin-8 expression in human dental pulp. The purpose of this study was to determine whether tissue levels of interleukin-8 are elevated in irreversibly inflamed human pulps. STUDY DESIGN: Experimental samples were from teeth clinically diagnosed with irreversible pulpitis (diseased pulps). Controls were from freshly extracted, caries-free third molars (normal pulps). Samples were subjected to enzyme-linked immunosorbent assay and/or immunohistochemical analysis with specific antibodies to interleukin-8. RESULTS: The enzyme-linked immunosorbent assay studies showed elevated levels of interleukin-8 in diseased pulps (mean, 1.82+/-0.79 pg/mL/microg protein), as compared to detectable interleukin-8 levels in samples from normal pulps (mean, 0.08+/-0.04 pg/mL/microg protein; P<.05). Immunohistochemical analyses demonstrated that diseased samples exhibited a higher density of localized interleukin-8 staining in areas with heavy infiltration of inflammatory cells. In contrast, normal pulps showed negative or weak interleukin-8 staining. CONCLUSIONS: Interleukin-8 concentration was higher in pulps diagnosed with irreversible pulpitis; only negligible amounts of interleukin-8 were present in normal pulps.

Antibodies↗
PubMed2001

BMP-7 gene transfer to inflamed ferret dental pulps.

In vivo and ex vivo gene transfer are being developed for localized skeletal regeneration. These strategies for tissue regeneration were tested in an adult ferret model of vital pulp therapy. In this model a reversible pulpitis was induced first. Then after 3 d, the pulps were directly infected with recombinant virus or implanted with ex vivo transduced autologous dermal fibroblasts. The genome of the recombinant adenovirus contained a full-length cDNA encoding mouse bone morphogenetic protein (BMP)-7 (AdBMP7) or bacterial beta-galactosidase cDNA (AdlacZ). The BMP-7, but not lacZ, ex vivo transduced dermal fibroblasts induced reparative dentinogenesis with apparent regeneration of the dentin-pulp complex. In vivo infection with AdBMP-7 failed to produce reparative dentin in all cases. E. vivo gene transfer of BMP-7 may be an effective method for inducing dentin regeneration in teeth with reversible pulpitis.

Adenoviridae↗
PubMed2001

Are antibiotics being used appropriately for emergency dental treatment?

AIM: To investigate the therapeutic prescribing of antibiotics to patients presenting for emergency dental treatment. DESIGN: A prospective clinical study. METHOD: Information was collected via a questionnaire concerning the patient's reason for attendance and treatment undertaken at emergency dental clinics in North and South Cheshire. RESULTS: Over an 11-week period 1,069 patients attended the five clinics, 1,011 questionnaires were analyzed. The majority of the attendees had pain (879/1011). 35% (311/879) of these patient had pulpitis and 74% (230/311) had been issued a prescription for antibiotics, without any active surgical intervention. Th principal antibiotic prescribed for both adult and child patients was amoxicillin. CONCLUSION: The majority of patients attending the emergency dental clinics had pain, with a large proportion having localised infections either as pulpitis or localised dental abscess. Three quarters of these patients had no surgical intervention and were inappropriately prescribed antibiotics.

Adolescent↗
PubMed2000

Anaerobic bacterial extracts influence production of matrix metalloproteinases and their inhibitors by human dental pulp cells.

The role of human dental pulp (HDP) cells in extracellular matrix degradation in pulpitis is still unclear. In this study, the effects of sonicated bacterial extracts (SBEs) from Prevotella intermedia, Fusobacterium nucleatum, Porphyromonas endodontalis, and Porphyromonas gingivalis on the balance between the production of matrix metalloproteinases (MMPs) and that of their inhibitors [tissue inhibitors of metalloproteinases (TIMPs)] by HDP cells were examined. HDP cells were treated with SBEs, and their culture media were later harvested. MMP activities and TIMP concentrations were determined by use of independent measurement strategies and sensitive ELISAs. The production of MMP-1 and MMP-2 was accelerated by all SBE. On the other hand, TIMP-1 production was slightly elevated; and TIMP-2 production was markedly inhibited by all of the extracts. SBEs derived from these anaerobic bacteria seemed to affect the acceleration of extracellular matrix degradation activity by HDP cells. These findings suggest that HDP cells stimulated by bacterial byproducts may be involved in the pathogenesis of pulpitis.

Bacteria, Anaerobic↗
PubMed2002

Differential regulation of interleukin-6 and inducible cyclooxygenase gene expression by cytokines through prostaglandin-dependent and -independent mechanisms in human dental pulp fibroblasts.

Increased levels of interleukin-1 (IL)-1, tumor necrosis factor-alpha (TNF-alpha), IL-6, and prostaglandin E2 (PGE2) have been detected in inflamed pulp tissue. To gain further insight into the molecular pathogenesis of pulpitis, we investigated the effects of IL-1alpha or TNF-alpha and PGE2, either alone or in combination on IL-6 and cyclooxygenase (COX)-2 messenger RNA (mRNA) production in cultured human dental pulp (HDP) fibroblasts. Exposure of HDP fibroblasts to IL-1alpha or TNF-alpha resulted in elevated levels of IL-6 (approximately 3.4 to approximately 10.4-fold) and COX-2 (approximately 5 to approximately 6.2-fold) mRNA. Simultaneous addition of IL-1alpha and PGE2 or TNF-alpha and PGE2 to the cultures significantly reduced the cytokine-induced IL-6 mRNA synthesis ranging from 45% to 65%. However, indomethacin enhanced the cytokine-stimulated IL-6 mRNA synthesis by approximately 1.7 to approximately 3.4-fold. This action could be reversed by exogenous PGE2. In contrast, PGE2 or indomethacin failed to modify the stimulatory effect of IL-1alpha or TNF-alpha on COX-2 gene expression. Because excessive levels of IL-6 and prostaglandins have been connected with the pathogenesis of several inflammatory diseases, our results suggest the involvement of HDP fibroblasts in the development of pulpitis via producing IL-6 and COX-2. Furthermore, expression of IL-6 and COX-2 genes in this cell seems to be differentially regulated by cytokines through prostaglandin-dependent and -independent pathways.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2005

Pulp-dentine complex changes and root resorption during intrusive orthodontic tooth movement in patients prescribed nabumetone.

Pulpitis, external root resorption, and pain may be experienced during orthodontic movement. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) has been suggested to control these changes. The purpose of this study was to observe pulp-dentinal reactions, root resorption, tooth pain, and tooth movement after the application of a 4-ounce intrusive orthodontic force to human maxillary first premolars in patients given the NSAID nabumetone. Thirty-four maxillary first premolars were evaluated. A placebo was prescribed to 17 patients after an intrusive force was activated and reactivated for an 8-week period on the right side. The same procedure was repeated on the left side after patients were given nabumetone. Pulp-dentinal reactions and external root resorption were evaluated by histology. Pain and movement were also evaluated. Nabumetone was found to be useful in reducing pulpitis, external root resorption, and pain caused by intrusive orthodontic movement, without altering tooth movement in response to the application of orthodontic force.

Adolescent↗