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PubMed2000

[Pharma clinics. How I treat...dental emergencies in general practice].

Counselling and drug prescription are the only means for the phycisian to manage dental emergencies. Among these, some are infection related: pulpitis, apical and periodontal abscesses, acute necrotizing ulcerative gingivitis and alveolitis. Urgent medical treatment includes antibiotics, mouth rinses and analgesics except for pulpitis (pain caused by thermal stimuli) for which analgesics alone are prescribed. Infection non related dental emergencies are: hemorrhage for which the best treatment is compression; trauma, mainly dental avulsion for which reimplantation must be done as soon as possible; acute TMD such as open lock which can be reduced by the Nelaton handling.

Emergency Treatment↗

PubMedDate not supplied

Indirect pulp treatment: in vivo outcomes of an adhesive resin system vs calcium hydroxide for protection of the dentin-pulp complex.

PURPOSE: The purpose of this prospective and randomized in vivo study was to compare the clinical and radiographic outcomes of an adhesive resin system vs a calcium hydroxide liner for protection of the dentin-pulp complex of primary molars treated with indirect pulp treatment. METHODS: Forty-eight primary molars with deep occlusal caries, but without preoperative signs and symptoms of irreversible pulpitis, received indirect pulp treatment and were restored with a composite resin (Z100). The teeth were randomly divided into 2 groups according to the material used for protection of the dentin-pulp complex: (1) adhesive resin system (Scotchbond MultiPurpose); and (2) calcium hydroxide liner (Dycal). These teeth were evaluated clinically and radiographicaly for 2 years. RESULTS: After 2 years, 83% (19/23) of the teeth treated with calcium hydroxide and 96% (24/25) of teeth treated with only the adhesive resin system presented a successful outcome, as determined by clinical and radiographic examination. Interradicular and/or periapical lesions were the most predominant signs of treatment failure, since 3 out of 23 teeth treated with calcium hydroxide and 1 out of 25 teeth treated with only adhesive resin presented this outcome. One tooth treated with the calcium hydroxide liner was diagnosed with internal root resorption at the 18-month examination. Of the 5 teeth diagnosed from radiographs as a failure of the indirect pulp treatment, none presented clinical signs/symptoms of pulpitis or necrosis such as the presence of fistula, enhanced tooth mobility, or pain. CONCLUSIONS: This study demonstrates that protection of the dentin-pulp complex of primary molars with an adhesive resin system results in similar clinical and radiographic 2-year outcomes as compared to calcium hydroxide when indirect pulp treatment is performed in Class I composite restorations.

Calcium Hydroxide↗

PubMed2002

Endodontic treatment of permanent teeth in children with a new calcium-carbamide-formaldehyde paste.

UNLABELLED: AIM, MATERIAL AND METHODS: Endodontic treatment of a total of 303 teeth with pulpitis and periodontitis was performed with a new calcium-carbamide-formaldehyde paste. In three children with fractured teeth with complications, the applied treatment was combined (2 teeth with apical osteotomy and 1 with cystectomy). Control examinations were carried out at months 6, 12 and 24 and clinically healthy teeth and teeth with complications were registered. RESULTS: In the pulpitis group the clinically healthy teeth were 97.55% +/- 1.08 at the 6th month; 96.85% +/- 1.26 at the 12th month and 92.92% +/- 2.41 at the 24th month. In teeth with periodontitis 91.56% +/- 3.05 were clinically healthy at the 6th month; 93.83% +/- 2.67 at the 12th month and 98.03% +/- 1.98 at the 24th month. No statistical significance of the differences between pulpites and periodontites was found (P > 0.05). Recovery of the bone structure was observed in the teeth with combined endodontic and surgical treatment at the 12th month. CONCLUSIONS: The calcium-carbamide-formaldehyde paste stimulates bone regeneration and closing of the apex without coloring the hard dental tissues.

Adolescent↗

PubMedDate not supplied

Evidence-based assessment: evaluation of the formocresol versus ferric sulfate primary molar pulpotomy.

PURPOSE: Formocresol and ferric sulfate were evaluated as pulpotomy medicaments using evidence-based dentistry principles. Formocresol has been challenged as a potential carcinogen and mutagen, leading to consideration of ferric sulfate. METHODS: The PICOT statement was: (P) In human carious primary molars with reversible coronal pulpitis, (I) does a pulpotomy performed with ferric sulfate, (C) compared with formocresol, (O) result in dinical/radiographic success, (T) in time periods up to exfoliation? Relevant papers (N=894) were identified from databases and inclusion criteria were applied; 94 papers remained (randomized clinical trials [RCTs]=7; clinical trials [CTs]=28; case-control studies=14; opinions, cohort, and cross-sectional studies=4; reviews=22; irretrievable papers=19). Three RCTs and 10 CTs (total teeth: formocresol=753; ferric sulfate=90) were meta-analyzed; 1 RCT and 1 CT were tested for homogeneity (odds ratios; 95% confidence intervals); 3 RCTs and 10 CTs were examined by student's t test. RESULTS: Clinical data indicated ferric sulfate was significantly more successful than formocresol (OR=1.95; CI=1.01-3.80). Radiographic data indicated no difference between medicaments (OR=0.90; CI=0.58-1.39). Medicaments did not differ with t-tests of clinical (P>.10) and radiographic (P>.50) data. CONCLUSIONS: This evidence-based assessment concluded that, in human carious primary molars with reversible coronal pulpitis, pulpotomies performed with either formocresol or ferric sulfate are likely to have similar clinical/radiographic success.

Child, Preschool↗

PubMed2006

[Expression of lipopolysaccharides signal receptors CD14 and TLR4 in human dental pulp tissue and fibroblasts].

OBJECTIVE: To investigate the expression of lipopolysaccharides (LPS) receptors CD14 and TLR4 in normal and inflamed human dental pulp tissue and fibroblasts and to determine the signal transduction pathway of LPS in pulpitis. METHODS: CD14 and TLR4 expression in healthy and inflammatory pulps was observed by immunohistochemistry. The rates of CD14 and TLR4 positive cells and the mean fluorescence intensity in in vitro cultured pulp fibroblasts before and after being stimulated by LPS. RESULTS: CD14 and TLR4 were not detected in healthy pulp tissues, but they were strongly positively stained in inflammatory pulps. Ratio of TLR4 positive cells and mean fluorescence intensity produced by the cells stimulated by LPS increased significantly compared with normal pulp cells. However, there were no CD14 expression in human dental pulp cells before and after LPS stimulation. CONCLUSIONS: This study revealed a significant increase in the expression of CD14 and TLR4 in inflamed human dental pulp tissue. Human dental pulp cells could be induced by LPS to express TLR4, which may play an important role in the process of pulpitis.

Cells, Cultured↗

PubMed1990

[Contribution to the treatment of children in the first aid medical service of the stomatological department].

At the first aid medical service of the stomatological department of a type II hospital with policlinic in the course of the calendar year a total of 1,761 children from 2-15 years were treated. During this period the staff treater 1,718 teeth and 43 times they treater soft tissues of the oral cavity. Most frequently periodontitis of the decidual teeth was treated, resorption of the root of a decidual tooth, pulpitis and caries. As to therapy, extractions were most frequent, followed by trepanation of the pulp cavity and treatment of the tooth by a provisional filling. The author draws attention to unsuitable therapeutic procedures such as trepanation of the pulp cavity in case of periodonititis of a decidual tooth and application of cobalt in pulpitis of a decidual tooth after the age of seven years. She emphasizes also the necessity to use local anaesthesia in extraction of decidual teeth.

Adolescent↗

PubMed1988

The tender tooth. Dentoalveolar, pericoronal, and periodontal infections.

Dental caries and periodontal disease are the most common afflictions of the tooth. These infectious diseases cause considerable pain and discomfort and ultimately loss of the tooth. Apart from local effects, these infections may extend beyond natural barriers and result in complications that can vary in severity from the excruciating pain of acute pulpitis to life-threatening infections of the deep fascial spaces of the head and neck. In this article, the clinical and pathologic features of dental caries, pulpitis, periapical abscess, pericoronitis, and periodontal infections are discussed as well as prevention and treatment of infections involving the tooth, with emphasis on endocarditis prophylaxis.

Child↗

PubMed1996

Comparison of functional characteristics of intradental A- and C-nerve fibres in dental pain.

The sensory nerve fibres in the pulp consist of myelinated A- and unmyelinated C-fibres which conduct nerve impulses. The A-fibres are larger in diameter and fast conducting. Most of the A-fibres are in the A-delta group, but also the existence of very fast A-beta fibres has been demonstrated. C-fibres are small and slow conducting. When natural stimuli such as heat, cold, drilling or drying of dentine with air blasts are applied on the tooth, the only sensation perceived seems to be that of pain. On the other hand perception of pain symptoms in clinical situations varies from sharp and piercing to dull and poorly localised. A- but not C-fibres respond to dentine stimulation, and therefore responsible for dentine sensitivity. When heat is applied to the tooth, there is a two-phase response. First there is an immediate A-fibre response followed by a C-fibre response. The A-fibres could be responsible for the sharp well localised pain in human subjects while C-fibres could be responsible for the dull pain radiating to other parts of the face. A-fibres are activated at a higher level of electrical stimulation than C-fibres. C-fibres, but not A-fibres respond to application of bradykinin and histamin. The functional differences in A- and C-fibres may be one explanation for the change in the pain symptoms which at the beginning of pulpitis are mediated by A-fibres and in advanced pulpitis by C-fibres.

Humans↗

PubMed1988

Inflammation of rat molar pulp and periodontium causes increased calcitonin gene-related peptide and axonal sprouting.

We have studied the response of nerve fibers containing calcitonin gene-related peptide immunoreactivity (CGRP-IR) to inflammation using a rate dental experimental system. Inflammation was induced by drilling tooth cusps to create pulpal exposures; the induced pulpitis and subsequent periapical lesions were studied 1-35 days later using standard CGRP immunohistochemistry and the avidin-biotin peroxidase method. The injury and resulting inflammation caused a disruption of CGRP-IR nerve fiber location and arborization that varied depending on whether the initial injury was limited to the pulp tip or extended throughout the pulp horn. At shorter survival periods (24 hr, 3 days) nerve fibers were either decreased or bundled into the center of the pulp with sprouting along the wound border. At 6 days necrosis and acute inflammation had advanced to varying degrees, and CGRP-IR fibers were extensively sprouted in the surviving pulp; the pulp also stained specifically for CGRP within 1-2 mm of the inflamed tissue at 6 days. At 35 days, we found total pulp necrosis in most teeth and the development of periapical bone loss, granulomatous tissue, and periapical abscesses. There was also an extensive increase in CGRP-IR nerve fibers in the tissues surrounding sites of severe periodontal inflammation and necrosis. In some cases, macrophage-like cells staining specifically for CGRP were near the abscesses. The results show important interactions between peptidergic nerve fibers and inflammatory cells, and are discussed in terms of the role of nerve fibers containing CGRP in neurogenic inflammation, mechanisms for intensification of CGRP immunoreactivity in affected fibers or neighboring cells, and implications for chronic inflammatory conditions, dental pain, and anesthesia.

Animals↗

PubMed1977

Ultrastructure of lymphatic capillaries in the human dental pulp.

Occlusal intradentinal cavities, prepared in normal human premolars and third molars to be extracted for orthodontic reasons, were filled for 7 to 11 days with gutta percha. A superficial pulpitis with localized small abscesses developed in the pulp chamber. Under local anesthesia, 0.2 to 0.3 cc of sterile colloidal carbon was injected in the pulp horn and the teeth were extracted 1 to 3 h later. Lymphatic capillaries could thus be identified in the pulpal tissues. They were characterized by a thin endothelium with occasional large intercellular clefts, absence or incompleteness of basement membrane, absence of pericytes, absence of luminal red blood cells, and presence of a filamentous material between the endothelium and the surrounding collagen fibrils. Moreover, some structural variations were observed.

Adolescent↗

PubMed1999

[Magnetic resonance tomography in dental radiology (dental MRI)].

PURPOSE: To demonstrate the usefulness of Dental-MRT for imaging of anatomic and pathologic conditions of the mandible and maxilla. METHODS: Seven healthy volunteers, 5 patients with pulpitis, 9 patients with dentigerous cysts, 5 patients after tooth transplantation and 12 patients with atrophic mandibles were evaluated. Studies of the jaws using axial T1- and T2-weighted gradient echo and spin echo sequences in 2D and 3D technique have been to performed. The acquired images were reconstructed with a standard dental software package on a workstation as panoramic and cross sectional views of the mandible or maxilla. RESULTS: The entire maxilla and mandibula, teeth, dental pulp and the content of the mandibular canal were well depicted. Patients with inflammatory disease of the pulp chamber demonstrate bone marrow edema in the periapical region. Dentigerous cysts and their relation to the surrounding structures are clearly shown. After contrast media application marked enhancement of the dental pulp can be found. CONCLUSION: Dental-MRT provides a valuable tool for visualization and detection of dental diseases.

Diagnostic Imaging↗

PubMed1994

The neurophysiological basis and the role of inflammatory reactions in dentine hypersensitivity.

Recent studies indicate that intradental A-type nerve fibres are responsible for the sensitivity of dentine and are activated by fluid movements in dentinal tubules (hydrodynamic mechanism). The patency of the tubules affects dentine sensitivity to a great extent. Both A delta- and A beta-type nerve fibres respond to dentinal (hydrodynamic) stimulation in a similar way. Only a few studies have been made on the regional sensitivity of dentine or the receptive areas of intradental nerve fibres. The results indicate that the fibres innervating different parts of coronal dentine are equally sensitive to dentinal stimulation but those in the cervical area may be less responsive. Inflammation in the pulp can considerably alter dentine sensitivity. In dog teeth with chronically exposed dentine, nerve responses to hydrodynamic stimulation were reduced although other functional changes indicated nerve sensitization. This may be due to spontaneously occurring changes in the exposed dentine that block the tubules. In acute experiments on cat and dog teeth with open dentinal tubules, certain inflammatory mediators increase the sensitivity of the responding nerve fibres. It seems that intradental C-fibres do not respond to hydrodynamic stimulation of dentine. They are polymodal and activated when external stimuli reach the pulp proper. They could perhaps mediate the dull pain connected with pulpitis. However, they might also have an important modifying effect on dentine sensitivity because they can release neuropeptides, which function in the inflammatory reactions.

Animals↗

PubMed1994

Performance of a glass ionomer luting cement over 8 years in a general practice.

For this report, 1230 cast restorations luted with a glass ionomer cement were followed up for 8 years. The results show an absence of secondary caries, 99% retention of restorations, and a 4% incidence of irreversible pulpitis. The infrequent thermal sensitivity previously observed after cementation in this group of restorations did not recur.

Biocompatible Materials↗

PubMed1988

The effect of collagen and indomethacin on inflamed dental pulp wounds of baboon teeth.

Following the induction of experimental pulpitis in baboon teeth, calf skin collagen, indomethacin, or zinc oxide-eugenol was used to dress exposed dental pulp wounds in selected teeth. The teeth were extracted after 7, 35, and 90 days fixed in formalin, and processed, for histopathologic examination. The inflammatory response to zinc oxide-eugenol remained moderate throughout the experiment, whereas the inflammatory response to indomethacin and collagen was present from the outset and became progressively more severe, especially with collagen. The amount of irritation dentin production, however, was greater in those dental pulps dressed with collagen and indomethacin.

Animals↗

PubMed1988

An evaluation of etiologic factors in 382 patients treated in a postgraduate endodontic program.

A survey was completed to determine and to evaluate the reason for endodontic treatment performed by endodontic residents at the Baltimore College of Dental Surgery, University of Maryland at Baltimore. On the basis of patient data and the reasons for endodontic treatment, as stated by the treating residents, the results showed that necrotic pulp and irreversible pulpitis were the most frequent reasons for endodontic therapy. Other reasons for treatment included restorative considerations, retreatment, and trauma. The majority of cases involved posterior teeth, and the average age of patients was 40.0 years. The frequency by arch demonstrated approximately equal distribution between maxillary (54.8%) and mandibular (45.2%) teeth. A total of 224 (58.6%) of the 382 patients surveyed had preoperative pain.

Adolescent↗

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↗

PubMed2006

The effects of tumor necrosis factor-alpha, interleukin-1beta, interleukin-6, and transforming growth factor-beta1 on pulp fibroblast mediated collagen degradation.

Dental pulp destruction is believed to be regulated, in part, by the matrix metalloproteinases (MMPs) and tissue inhibitors of MMPs (TIMPs). Cytokines are believed to be important in the pathogenesis of pulpitis. This study examined the effects that TNF-alpha, IL-1beta, IL-6, and TGF-beta1 have on the collagen degradation mediated by pulp fibroblasts utilizing a cell-mediated collagen degradation assay. Reverse transcriptase-polymerase chain reaction, Western blot analyses, and zymography were utilized to examine multiple MMPs and TIMPs. The collagen degradation mediated by these cells was stimulated by these cytokines. TNF-alpha, IL-1beta, and IL-6 increased the mRNA and/or protein expression of MMP-1, MMP-2, and MMP-3. TGF-beta1 decreased MMP-1 mRNA expression, while only slightly affecting the MMP-2 and MMP-3 mRNA and/or protein. These cytokines did not affect the expression of TIMP-1 or TIMP-2. These results suggest that these cytokines affect pulp destruction, in part, by differentially regulating the MMPs and TIMPs.

Adult↗

PubMed2004

Catastrophizing predicts changes in thermal pain responses after resolution of acute dental pain.

UNLABELLED: Substantial research suggests that coping strategies, especially catastrophizing, play an important role in shaping adjustment to chronic pain. Although laboratory and clinical studies both suggest that catastrophizing enhances pain, the interaction of catastrophizing and clinical pain on pain sensitivity has received little attention. The present study evaluated the extent to which catastrophizing influenced laboratory thermal pain responses during and after the resolution of acute dental pain. Thermal pain threshold and tolerance, as well as self-reported catastrophizing, were determined in 46 dental patients (15 men and 31 women) experiencing pain as a result of acute pulpitis. All subjects participated in 2 experimental sessions; the first took place immediately before endodontic treatment for relief of pulpal pain, and the second session occurred when patients were pain free, approximately 1 to 2 weeks later. Thermal pain thresholds increased on resolution of acute dental pain, whereas levels of catastrophizing did not change from pretreatment to post-treatment. Catastrophizing was unrelated to thermal pain responses in the presence of acute dental pain (ie, during the first session). Once patients were pain free, catastrophizing showed significant inverse associations with measures of thermal pain threshold and tolerance. In addition, catastrophizing was a robust predictor of changes in thermal pain responses across sessions, with higher baseline catastrophizing predicting reductions or relatively smaller increases in pain threshold and tolerance after successful treatment of acute pain. These data suggest that catastrophizing is prospectively associated with enhanced sensitivity to and reduced tolerance for thermal pain. The use of catastrophizing as a coping strategy might interfere with the resolution of sensitization after cessation of an acutely painful condition, or it might be associated with magnified experimental pain responses across time. PERSPECTIVE: The findings of the present study suggest that, in some instances, different ethnic groups and genders may use the same descriptors to report different levels of pain. In the context of clinical pain assessment, it may be important to consider the possibility that descriptions of painful sensations reflect, in part, demographic characteristics.

Adaptation, Psychological↗