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PubMed1990

Immunoglobulin and haematocrit values of dental pulp showing hyperaemia and acute serious pulpitis.

In this study, we examined how the pulpal immune systems differ in children who suffer from hyperaemia and acute serous pulpitis. The Radial Immune Diffusion (RID) method was used to measure the IgA, IgG and IgM levels in pulpal blood in hyperaemia and acute serous pulpitis cases. The patient's own peripheral blood was used as the control group. The peripheral blood was taken with a capillary tube from the finger tip. The immunoglobulins and the Htc values of the blood were measured by the radial immune diffusion method. In our research, the immunoglobulin and hematocrit values of the blood (pulpal and peripheral) of 39 patients between the ages 6 to 13 years were measured. No significant difference was found between the IgA, IgG and IgM levels of pulpal and peripheral blood in hyperaemia and acute serous pulpitis cases. In the same patients, a significant difference was noted between the Htc values of the pulpal and peripheral blood.

Child↗
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↗
PubMed1999

Histochemical observation of nitric oxide synthase in trigeminal ganglion of rats with experimental pulpitis.

In order to understand the roles of nitric oxide (NO) in pulpalgia and pulpitis, the histochemistry of nitric oxide synthase (NOS) in the neurons of trigeminal ganglion in experimental pulpitis rat and human inflammatory dental pulp tissues were histochemically studied by NADPH-diaphorase (NADPH-D) techniques. Results showed that NADPH-D positive neurons were scattered in rat trigeminal ganglions, but the sizes of positive neurons were not changed. None of NOS-positive fibers was found in human normal and inflammatory dental pulp tissues. The results suggested that NOS in trigeminal ganglion might play an important role in sensory transmission and regulation of pulpalgia. The absence of NOS-positive nerves in human pulp suggested that NO may not be related to inflammatory stimulation and transmission in dental pulp tissues.

Animals↗
PubMed2006

Electronic root canal length measurement before and after experimentally induced pulpitis and apical periodontitis in dogs.

The aim of the study was to examine the influence of the state of the pulp and apical periodontium on the results of electronic root canal length measurement (ERCLM) with a resistance measuring device in dogs. Pulpitis and apical periodontitis were induced by pulp exposure and contamination by the oral flora in the premolar teeth of six mongrel dogs, comprising four experimental groups (36 root canals). In a control group, measured lengths of teeth with uninfected pulps were performed on the first experimental day (44 root canals). In all animals the ERCLMs were performed on teeth with healthy pulps, and at the end of the experimental period (20, 35, 50 and 65 days) following pulp exposure. The point of measuring canal lengths was the anatomical obstacle above the apical delta. Electronically measured lengths (EML) were compared between each other and with the root canal length established by tactile-sense measurement verified radiographically. The EMLs were less accurate in teeth with healthy pulps and teeth with pulpitis in the third experimental group (dif=2.27 x 2.65 mm(2); t test, p<0.05), while they were most precise after 65 days in teeth with completely necrotic pulp and established chronic apical periodontitis (dif=0.54 x 1.36 mm(2); t test, p>0.05). These results suggest that the state of the pulp and periapical tissue may have an influence on the ERCLM.

Animals↗
PubMed1977

The effect of a proteolytic enzyem mixture (Orenzyme-Forte) on experimentally induced pulpitis.

A proteolytic enzyme mixture, Orenzyme-Forte, containing trypsin, chymotrypsin, and ribonuclease was used to treat experimentally induced pulpitis in the teeth of three monkeys. Assessment by means of the criteria of Stanley showed that the enzyme mixture induced better healing than a zinc oxide--eugenol dressing. When the two were used simultaneously, a synergistic effect was seen. We suggest that this enzyme mixture may be useful in clinical practice in the treatment of pulpitis.

Animals↗
PubMed1983

Cold as a diagnostic aid in cases of irreversible pulpitis. Report of two cases.

Two case reports are presented to illustrate the effectiveness of cold in localizing the offending tooth in difficult diagnostic situations where painful pulpitis is present. A review of the literature reveals that there are several proposed theories concerning the mechanisms by which cold relieves the painful symptoms present in some cases of irreversible pulpitis. The hydrodynamic theory seems to provide the most feasible explanation of the events that occur.

Cold Temperature↗
PubMed1992

Postoperative pain incidence related to the type of emergency treatment of symptomatic pulpitis.

Some endodontic emergencies occur as a result of attempts to relieve symptoms of pulpitis. The aim of this study was to identify any predictor of postoperative pain in a patient population treated by dental students. Patients who reported for treatment of symptomatic pulpitis were subjected to three different emergency treatment regimens. Clinical data was collected on those patients who reported in the emergency service with severe postoperative pain within 24 hours of emergency endodontic treatment. Statistical analysis of these data suggested that the type of endodontic emergency procedure carried out was a significant predictor of severe postoperative pain.

Adolescent↗
PubMed2002

Is pulpitis painful?

AIM: To determine whether inflamed dental pulps progress to necrosis without pain. METHODOLOGY: Records of 2,202 maxillary anterior teeth endodontically treated at the University of Michigan were collected. Records of teeth presenting with periapical radiolucencies but no response to vitality tests were examined further to determine, from the history, whether the patient had experienced pain or no pain from the involved tooth. RESULTS: Approximately 40% of the teeth included gave no history of spontaneous or prolonged pain to a thermal stimulus. No statistically significant differences in the incidence of 'painless pulpitis' were related to either gender or tooth type. Patients aged >53 years experienced 'painless pulpitis' more often than patients <33 years. CONCLUSIONS: Many teeth appear to progress to pulpal necrosis without the patient experiencing pain attributable to the pulp.

Adult↗
PubMed2003

Effect of an intraosseous injection of depo-medrol on pulpal concentrations of PGE2 and IL-8 in untreated irreversible pulpitis.

The purpose of this prospective, randomized, double-blind study was to evaluate the pulpal concentrations of prostaglandin E2 (PGE2) and interleukin-8 (IL-8) in untreated teeth with irreversible pulpitis after the administration of an intraosseous injection of Depo-Medrol. Forty emergency patients with a clinical diagnosis of irreversible pulpitis experiencing moderate to severe pain participated. After receiving local anesthesia, patients randomly received, in a double-blind manner, an intraosseous injection of either 1 ml of Depo-Medrol (40 mg) (20 patients) or 1 ml of sterile saline placebo (control) (20 patients). No endodontic treatment was initiated. At 1 or 3 days after the intraosseous injection, the teeth were extracted and the pulpal tissue harvested. Prostaglandin E2 and interleukin-8 concentrations were determined by enzyme immunoassay. Results demonstrated a significantly (p < 0.05) lower concentration of prostaglandin E2 compared to the saline group at day 1. There were no significant (p > 0.05) differences between the two groups at day 3. The pulpal concentrations of prostaglandin E2 were reduced at 1 day after the intraosseous injection of Depo-Medrol.

Adult↗
PubMed1993

Neural changes in ulcerative and hyperplastic pulpitis: a transmission electron microscopic study.

The purpose of this study was to examine at ultrastructural level the neural changes in human apical pulps of teeth clinically diagnosed as having ulcerative or hyperplastic pulpitis. Seventeen specimens were prepared from six teeth with ulcerative or hyperplastic pulpitis and four specimens from two sound teeth. After routine procedures the specimens were examined under an electron microscope for changes in the structure of myelinated and unmyelinated nerve fibres. Although the teeth used in this study responded positively to vitality test, the results revealed that moderate to severe degenerative changes occurred in the nerve fibres of the apical pulps of the teeth showing these two diseases.

Dental Pulp↗
PubMed2005

The use of an intra-oral injection of ketorolac in the treatment of irreversible pulpitis.

AIM: To examine whether an intra-oral injection of a nonsteroidal anti-inflammatory drug (ketorolac), in association with conventional local anaesthetic techniques, would improve the pulp extirpation rate in teeth with irreversible pulpitis. METHODOLOGY: A two group double-blind clinical trial was undertaken in the Dental Casualty Department of the University of Manchester School of Dentistry. Patients were randomly allocated to either the test or control group. The test group received an intra-oral injection of ketorolac (30 mg in 1 mL) in the buccal sulcus adjacent to the tooth being treated. After an interval of 15 min, they then received 2.2 mL of 2% lidocaine with 1 : 80 000 epinephrine by buccal infiltration in the maxilla or by inferior dental block in the mandible. The control group received an intra-oral injection of normal saline (1 mL) in the buccal sulcus adjacent to the tooth being treated, followed by the same local anaesthetic regime as the test group after the 15 min interval. Fifteen minutes after the local anaesthetic injections, pulp extirpation was attempted. All patients completed the short-form McGill pain questionnaire prior to treatment and completed identical questionnaires at 6 and 24 h after treatment. RESULTS: The study protocol set the number of patients to be treated at twenty. However, as the study progressed it became apparent that the intra-oral injection of ketorolac caused significant pain to four of the five patients who received it; therefore the study was terminated after ten patients had been treated. The results from the patients treated showed no significant difference in the pulp extirpation rate between the test and control groups. However, patients with higher pain scores at baseline were less likely to have the pulp completely extirpated, irrespective of whether they were in the test or control group. Pain scores for all patients decreased significantly from baseline to 24 h. CONCLUSION: An intra-oral injection of ketorolac did not improve the pulp extirpation rate in a small group of patients with irreversible pulpitis compared with a placebo. In addition, it was associated with such significant pain on injection that it cannot be recommended as a treatment in this situation.

Adult↗
PubMed1998

Lateral condensation in treatment of pulpitis and pulp gangrene: studies on dog canine teeth.

The clinical investigation, carried out in dogs, comprises selected cases of chronic pulpitis and pulpal gangrene of canine teeth resulting from injuries. A group of 20 teeth (group 1) underwent extirpation of pulp, as well as elaboration of a root canal and its filling with Endomethasone paste, under general anaesthesia during a one-stage procedure. The second group of 20 teeth differed from the first in an additional concentration of the paste, due to an introduction of gutta-percha points (lateral condensation). This sealing modification proved to diminish the risk of leaving empty spaces after pulp removal in the pulpitis state. However, in teeth where gangrenous pulp extirpation was performed, lateral condensation was endangered by pushing the paste through beyond the apex. Both anomalies were likely to predispose to the development of apical periodontitis.

Animals↗
PubMed1977

Pulp reactions to silicate cement in teeth with healing pulpitis.

Unlined silicate restorations were placed in intact and experimentally altered monkey, teeth. Pulpitis had been induced experimentally by sealing soft carious human dentin in Class V cavities with amalgam for 7 d. These fillings were then removed and healing allowed by inserting zinc oxide/eugenol cement. A protective effect of the secondary dentin in teeth with healing pulpitis could be demonstrated in short-term experiments. After a 1-month observation period no difference in response to silicate cement could be found between intact and experimentally altered pulps, both groups exhibiting no or slight pulp reactions and secondary dentin formations.

Animals↗
PubMed1979

Pulpotomy of primary molars with coronal or total pulpitis using formocresol technique.

The aim of this study was to evaluate whether formocresol can be used successfully in teeth with carious exposure and a vital pulp with clinical symptoms of chronic pulpitis. Further, the study concerned the influence on the success rate of the vehicle for formocresol. Pulpotomies were performed on 81 primary molars. Radiographic and other clinical symptoms were used to divide the material into a coronal chronic and a total chronic pulpitis group. Chosen by lot, zinc oxide-eugenol or Pharmatec (a plaster-like non-eugenol cement) was used as the vehicle for formocresol. After an observation period of 2.5 years the success rate for the whole material was 55%. No statistically significant difference in the rate of success could be demonstrated either between the two diagnostic groups or between the two vehicle groups.

Bandages↗
PubMed2004

Effects of an inducible nitric oxide synthase inhibitor on experimentally induced rat pulpitis.

Nitric oxide (NO) is a biological effector molecule involved in a large variety of reactions and, as synthesized by inducible nitric oxide synthase (iNOS), has many important roles in inflammatory conditions. This study aimed to evaluate the anti-inflammatory effects of an iNOS-specific inhibitor, N-(3-(aminomethyl)benzyl)acetamidine (1400W), on experimentally induced rat pulpitis in the upper incisors of 6-wk-old male Wistar rats. 1400W (1 mg kg(-1)), the non-specific NOS inhibitor N(G)-nitro-L-arginine methyl ester (L-NAME, 50 mg kg(-1)), or sterile saline (control) were administered before the application of lipopolysaccharide (LPS). Rats were killed 3, 6, 9, 12, 24, 48, and 72 h after LPS application, and immunocompetent cells were detected immunohistochemically. The numbers of granulocytes infiltrating into the pulp were significantly depressed in the 1400W group compared with the saline and L-NAME groups. The kinetics of the macrophages and Ia(+) cells in the 1400W group were similar to those in the L-NAME group, while the maximum numbers in both groups were significantly reduced compared with those in the saline group. These results suggest that NO may be responsible for the infiltration of immunocompetent cells in the progress of pulpitis, and that 1400W is a promising candidate for controlling pulpal inflammatory reactions.

Amidines↗
PubMed2002

Quantitative microbiological study of human carious dentine by culture and real-time PCR: association of anaerobes with histopathological changes in chronic pulpitis.

The bacteria found in carious dentine were correlated with the tissue response of the dental pulps of 65 teeth extracted from patients with advanced caries and pulpitis. Standardized homogenates of carious dentine were plated onto selective and nonselective media under anaerobic and microaerophilic conditions. In addition, real-time PCR was used to quantify the recovery of anaerobic bacteria. Primers and fluorogenic probes were designed to detect the total anaerobic microbial load, the genera Prevotella and Fusobacterium, and the species Prevotella melaninogenica, Porphyromonas endodontalis, Porphyromonas gingivalis, and Micromonas (formerly Peptostreptococcus) micros. The pulpal pathology was categorized according to the cellular response and degenerative changes. Analysis of cultured bacteria showed a predominance of gram-positive microorganisms, particularly lactobacilli. Gram-negative bacteria were also present in significant numbers with Prevotella spp., the most numerous anaerobic group cultured. Real-time PCR analysis indicated a greater microbial load than that determined by colony counting. The total number of anaerobes detected was 41-fold greater by real-time PCR than by colony counting, while the numbers of Prevotella and Fusobacterium spp. detected were 82- and 2.4-fold greater by real-time PCR than by colony counting, respectively. Real-time PCR also identified M. micros, P. endodontalis, and P. gingivalis in 71, 60, and 52% of carious samples, respectively. Correlation matrices of the real-time PCR data revealed significant positive associations between M. micros and P. endodontalis detection and inflammatory degeneration of pulpal tissues. These anaerobes have been strongly implicated in endodontic infections that occur as sequelae to carious pulpitis. Accordingly, the data suggest that the presence of high levels of these bacteria in carious lesions may be indicative of irreversible pulpal pathology.

Bacteria, Anaerobic↗
PubMed2005

Effect of NOS inhibitor on cytokine and COX2 expression in rat pulpitis.

Various kinds of chemical mediators are synthesized in the course of pulpitis; thus, control of their production would assist in inducing a reduction in pulpal inflammation. We hypothesized that nitric oxide (NO) would be an important mediator of pulpal inflammation. Pulpal inflammation was induced by the application of LPS in rat incisor pulp, and inducible nitric oxide synthase (iNOS) expression was evaluated by reverse-transcription/polymerase chain-reaction and immunohistochemical staining. After LPS application, iNOS mRNA was first detected after 3 hrs, peaked at 6 hrs, and decreased thereafter. iNOS-positive cells were macrophages and neutrophils. An NOS inhibitor caused drastic decreases in the expression of pro-inflammatory cytokines and COX2 mRNA, which was highly induced in the LPS-induced pulpitis. These results indicate that NO synthesis is related to the initiation of mediator production, and that its down-regulation should contribute to the prevention of pro-inflammatory mediator synthesis.

Analysis of Variance↗
PubMed2004

Success of an alternative for interim management of irreversible pulpitis.

BACKGROUND: Extraction and endodontic therapy are treatment options for irreversible pulpitis. Extraction often is chosen for financial reasons. The authors conducted a study to investigate an alternative interim therapy. METHODS: The authors recruited patients (N = 73) with irreversible pulpitis and whose teeth were restorable but who opted for extraction owing to financial reasons. After undergoing pulpotomy, the teeth were restored by random assignment with one of two intermediate restorative materials: Caulk IRM (Dentsply Caulk, Milford, Del.) (Group I, n = 38) or an IRM base with glass ionomer core (Fuji IX GP, GC America, Alsip, Ill.) (Group II, n = 35). The authors monitored the teeth over six and 12 months for pain, integrity of restoration and radiographic periapical status by densitometric analysis. RESULTS: By six months, 10 percent of subjects remaining in the study (Group I, n = 27; Group II, n = 25) reported pain; by 12 months, 22 percent (Group I, n = 22; Group II, n = 18) reported pain. A two-tailed Fisher exact test showed no significant difference (P > or = .05) between groups at either time interval. No apical radiographic change was noted in 49 percent of teeth at six months (Group I, n = 18; Group II, n = 19) and 42 percent at 12 months (Group I, n = 16; Group II, n = 15). Chi2 analysis demonstrated no significant differences (P > or = .05) between groups. Seven of 22 restorations in Group I and four of 18 in Group II required repair at 12 months with no statistical difference (chi2 analysis, P > or = .05). CONCLUSIONS: The interim treatment of eugenol pulpotomy using either restorative material reliably prevented pain for six months. For longer periods, both restorations may require repair. CLINICAL IMPLICATIONS: This option should preserve the integrity of the arch and extend the use of the tooth while the patient finds the means to finance complete endodontic treatment.

Absorptiometry, Photon↗