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At least 649 records · Page 36Linked to original sources
PubMed1994

Chronic pain associated with a foreign body left under the soft tissue flap during periapical surgery.

A case is reported of a patient who requested treatment for chronic pain of 7 yr duration. After several unsuccessful endodontic procedures, a cotton pellet was discovered under the soft tissue near the apex of the left maxillary cuspid. It was theorized that the cotton was left under the tissue flap during a previous apicoectomy procedure. After the cotton was removed the patient subsequentially reported that the pain was relieved.

Adult↗
PubMed1994

Utilization of ketorolac tromethamine for control of severe odontogenic pain.

Ketorolac tromethamine (KT) (Toradol, 60 mg to 2 ml), an injectable nonsteroidal anti-inflammatory drug, was compared with a placebo (sodium chloride, 0.9%) for analgesic effects in patients presenting with severe odontogenic pain. Utilizing a double-blind protocol, KT and placebo were administered and evaluated. Forty patients presenting with severe odontogenic pain (75 to 100 mm and above utilizing the visual analog scale of 100 mm) recorded their visual analog scale score once every 10 min for 90 min after injection of either KT or placebo and before initiating traditional incision and drainage, endodontic therapy, and/or extraction. Results indicate that KT patients had significantly less pain from 20 to 90 min postadministration than those receiving placebo. By the 90-min period, KT patients were reporting negligible discomfort. Observed side effects included lightheadedness and injection site pain. It was concluded that KT effectively reduces severe odontogenic pain within 40 min after administration in human subjects, with minimal side effects.

Adult↗
PubMed1994

Distribution of injected dexamethasone from the buccal vestibule of the rat mandible.

Thirty-six Sprague-Dawley rats were divided into three groups of 12. Group 1 was a control, whereas group 2 had the dental pulp of the first mandibular molar acutely exposed, and group 3 had dental pulp exposure for 10 days. All animals were injected with 125I-labeled dexamethasone phosphate into the right mandibular vestibule. Each group of 12 was divided into subgroups of 4 and sacrificed at 1, 2, or 4 h. The soft tissue on the buccal side and the mandible with the molars were collected and the radioactivity determined. Dexamethasone was absorbed from the injection site and distributed to the ipsilateral mandible and to the contralateral muscle and bone similarly, regardless of the treatment. Results also indicate a possible osseous affinity for this steroid, which could be beneficial in relieving the pain of intraosseous endodontic flare-ups.

Administration, Buccal↗
PubMed1994

Effectiveness of various medications on postoperative pain following complete instrumentation.

The root canals of 588 consecutive nonsurgical patients with varying levels of pain were completely instrumented in 10 endodontic practices and 4 endodontic graduate programs. The participants were sequentially assigned to one of nine medications and a placebo. The severity of pain was assessed by the visual analog scale for 72 h following instrumentation. Among all of the parameters studied, three factors (preoperative pain, apprehension, and types of medication) were found to be significant in determining postinstrumentation pain. An association was found between the intensity of pre-and postoperative pain. As the intensity of preoperative pain increased, the chances for more severe postoperative pain increased (p < 0.0001). In addition, an association between the presence of apprehension before any treatment and postoperative pain was also noted (between 0.012 < p < 0.047). Examination of the time-effect curves for various medications in patients with no mild pain showed no statistical significant difference between the effectiveness of different medications and placebo. However, a multiple comparison of the effectiveness of various medications and placebo on patients in moderate and severe preoperative pain showed that ibuprofen, ketoprofen, erythromycin base, penicillin, and methylprednisolone plus penicillin were more effective than placebo within the first 48 h following complete instrumentation.

Acetaminophen↗
PubMed1993

Dental pain: self-observations by a neurophysiologist.

This is a description of a dentally trained neurophysiologist's first-hand experience of the slow and progressive deterioration of the pulp of one of his posterior teeth. He describes his sensations throughout the course of the pulpal pathosis and his experience as a patient undergoing endodontic treatment for the first time. His subjective experiences are put into the context of the current understanding of the physiology of pain.

Adult↗
PubMed1992

Adverse response to vital bleaching.

A case study is presented that described an acute flare-up of a tooth following a vital bleaching procedure. The case illustrates (a) the importance of assessing the pulpal and periradicular status of a tooth prior to any vital bleaching procedure; and (b) the alteration of the local adaptation syndrome by the bleaching agent.

Adult↗
PubMed1993

Correlation between thermal sensitivity and microorganisms isolated from deep carious dentin.

The correlation between thermal sensitivity and the microorganisms present in 29 deep carious lesions was studied. The numbers of lactobacilli and total Gram-positive rods in the carious lesions were found to be negatively related to the length of pain triggered by cold and heat stimulants. The presence of Gram-positive cocci and non-black-pigmented Bacteroides were positively associated with both cold and heat sensitivities. Black-pigmented Bacteroides, Streptococcus mutans, and total anaerobic colony counts were positively related to the heat sensitivity. Recovery of Fusobacterium nucleatum, Actinomyces viscosus, and enterics on the selective plates was associated with cold sensitivity. Total counts of Gram-positive cocci and Gram-negative rods on the anaerobic nonselective medium were positively related to the cold sensitivity. It appeared that teeth with low numbers of lactobacilli in the carious lesions usually responded to thermal tests with longer duration of pain. Conversely, teeth with high numbers of lactobacilli in the carious lesions usually responded with shorter duration of pain.

Bacteroides↗
PubMed1993

Effect of variable doses of dexamethasone on posttreatment endodontic pain.

One hundred six patients with pretreatment pain presenting for endodontic treatment participated in a controlled double blind study. After root canal therapy, the patients were given an intraoral intramuscular injection of either a saline placebo or various dosages of dexamethasone. Posttreatment pain incidence and severity were evaluated at 4, 8, 24, 48, and 72 h. Injection of the various dosages of dexamethasone, taken as a group, was shown to significantly reduce the severity of pain at 4 and 8 h, and 0.07 to 0.09 mg/kg dosage alone significantly reduced pain at 8 h. Patients who received dexamethasone took significantly fewer posttreatment pain medications than those who received the placebo. Although there was a trend toward a reduction in the incidence of posttreatment pain for patients who received dexamethasone, the difference was not statistically significant.

Analysis of Variance↗
PubMed1999

Comparison of effect of intracanal use of ketorolac tromethamine and dexamethasone with oral ibuprofen on post treatment endodontic pain.

The purpose of this study was to compare the pain-reducing efficacy of dexamethasone and ketorolac tromethamine when used as an intracanal medication, with oral ibuprofen and a placebo. An additional objective was to establish if any relationship exists between the incidence and severity of pretreatment pain and the incidence and severity of postinstrumentation pain. A total of 48 patients who presented to the University of Illinois postgraduate endodontic clinic were invited to participate. Patients were randomly assigned to 1 of 4 groups: oral ibuprofen, placebo, dexamethasone, or ketorolac tromethamine. Patients were asked to evaluate their pretreatment pain when they presented to the clinic with a Visual Analog Scale. The root canal treatment was performed in two appointments. The first appointment consisted of cleansing and shaping of the canal/s and placement of an intracanal medication. All teeth were closed with a sterile cotton pellet and IRM. Each patient was sent home with a Visual Analog Scale to fill out at 6, 12, 24 and 48 h after initiation of therapy. At the 12-h period, both dexamethasone and ketorolac provided statistically significant better pain relief than placebo. At the 24-h period, only ketorolac demonstrated better pain relief than the placebo. There were no statistically significant differences among the groups at 6 and 48 h. Although ibuprofen pain ratings were less than the placebo at all time points, the reduction was not significant. In addition, no significant differences were demonstrated between ibuprofen and either dexamethasone or ketorolac.

Adolescent↗
PubMed1994

Relationship between clinical symptoms and enzyme-producing bacteria isolated from infected root canals.

The object of this study was to determine the correlation between clinical symptoms and the activity of enzymes such as collagenase, chondroitinase, and hyaluronidase produced by bacteria isolated from infected root canals. The materials examined consisted of 28 teeth with apical periodontitis from 25 patients. Bacteria producing collagenase or chondroitinase and hyaluronidase were found to be significantly related to subacute clinical symptoms involving percussion pain. The frequency of bacteria producing collagenase was higher in isolates from root canals with a radiolucent area over 5 mm in diameter than in those from canals having a radiolucent area less than 5 mm in diameter.

Adult↗
PubMed1992

Delayed root canal therapy: an analysis of treatment over time.

A retrospective study of 898 teeth receiving root canal therapy was performed to document the sequelae of delayed completion of root canal treatment. Teeth were categorized into a prompt treatment group and a delayed treatment group. Comparisons of prompt and delayed treatment groups were made with regard to preoperative pain, interappointment emergencies, postobturation pain, and final treatment. Findings from this study show that a palliative endodontic procedure is an extremely effective treatment. However, 56% of teeth with incomplete root canal therapy eventually were extracted compared with 2 to 3% for the root canal filling treatment groups. By emphasizing the potential loss of the tooth rather than the potential of interappointment emergencies, the clinician may be more effective in achieving compliance among patients receiving delayed treatment.

Acute Disease↗
PubMed1992

Incidence of interappointment emergency associated with endodontic therapy.

Endodontic interappointment emergency (EIE) occurs in a low incidence following treatment by qualified operators. The purpose of this study was to assess the incidence of EIE after treatment by undergraduate students and to examine its correlation with preoperative and operative parameters. Randomly selected 334 records were retrospectively surveyed for unscheduled emergency appointments following endodontic treatment by undergraduate students. Treatment included step-back canal preparation in multiple visits with formocresol interappointment dressing. The incidence of EIE was 4.2%, and unrelated to the patients' sex and age or to tooth location. It was significantly higher in nonvital than in vital teeth (p < 0.05), with the highest occurrence in nonvital teeth unassociated with periapical radiolucency. Clinically, EIE was associated with swelling in half of the cases. It is concluded that the incidence of EIE following treatment by undergraduate students is low and related to tooth vitality.

Acute Disease↗
PubMed1992

Endodontic interappointment flare-ups: a prospective study of incidence and related factors.

Severe pain and/or swelling following a root canal treatment appointment are serious sequelae. Information varies or is incomplete as to the incidence of these conditions and related factors. In this study, data were collected at root canal treatment appointments on demographics, pulp/periapical diagnoses, presenting symptoms, treatment procedures, and number of appointments. Patients that then experienced a flare-up (a severe problem requiring an unscheduled visit and treatment) had the correlating factors examined. Statistical determinations were by chi-square analysis with significance at 0.05 or less. Nine hundred forty-six visits resulted in an incidence of 3.17% flare-ups. Flare-ups were positively correlated with more severe presenting symptoms, pulp necrosis with painful apical pathosis, and patients on analgesics. Fewer flare-ups occurred in undergraduate patients and following obturation procedures. There was no correlation between patient demographics or systemic conditions, number of appointments, treatment procedures, or taking antibiotics.

Acute Disease↗
PubMed1990

Neuropeptides in the dental pulp: distribution, origins, and correlation.

It is known that many factors participate in the process of inflammation and pain transmission. Recently, various neuropeptides have been demonstrated in the intrapulpal nerve fibers immunobiohistochemically. These neuropeptides may play some role in the process of inflammation and transmission of pain sensation. In this presentation, the distribution, origins, and correlation of neuropeptides in the dental pulp is reviewed.

Dental Pulp↗
PubMed1991

Cavitational bone defect: a diagnostic challenge.

A patient with a history of trauma to the maxillary left anterior region presented with chronic pain of unknown etiology. Root canal therapy and periradicular surgery failed to resolve the persistent pain. A second surgical procedure revealed a bone cavity superior and distopalatally to the apex of the maxillary left lateral incisor. The suspected etiology was necrotic bone removed from the bone cavity.

Adult↗