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PubMed1999

A comparison of ketorolac tromethamine and acetaminophen codeine in the management of acute apical periodontitis.

Effective management of severe endodontic pain is often a major problem. The analgesic effect of ketorolac tromethamine (Toradol, 10 mg p.o.) was compared with acetaminophen codeine (325 mg/15 mg p.o.) in patients with severe pain due to acute apical periodontitis in a double-blind clinical study. A total of 66 patients presenting with severe pain (defined as 7 cm and more using a visual analog scale) were randomly assigned to receive either ketorolac tromethamine or acetaminophen codeine (33 patients in each group), and recorded their pain score once every 10 min for 90 min after administration. Results indicate that patients in the ketorolac group had significantly less pain than those who received acetaminophen codeine (p = 0.005).

Acetaminophen↗
PubMed1999

An evaluation of endodontically treated vertically fractured teeth.

For this survey, 92 vertically fractured endodontically treated teeth were evaluated clinically and radiographically before and after extraction. The maxillary second premolars (27.2%) and mesial roots of the mandibular molars (24%) were the most fractured teeth. In 67.4% of the teeth, a solitary buccal pocket was present; in 34.8%, a fistula frequently appeared closer to the gingival margin than to the apical area. A lateral radiolucency or a combination of lateral and periapical radiolucency was found in more than half of the cases. The general practitioners correctly diagnosed vertical root fracture in only one-third of the 92 fractured teeth in this survey.

Adolescent↗
PubMed1999

Evaluation of the combination of flurbiprofen and tramadol for management of endodontic pain.

Effective management of endodontic pain represents a continuing challenge. In this study, we evaluated the efficacy of flurbiprofen and a novel centrally acting analgesic, tramadol, alone and in combination, for reducing pain in endodontic emergency patients. Patients (n = 49) were administered a local anesthetic and underwent pulpectomy. They were then administered, on a double-blind basis, either: (i) placebo (one capsule to start and then every 6 h); (ii) flurbiprofen (100 mg loading dose and then 50 mg every 6 h); (iii) tramadol (100 mg loading dose and then 100 mg every 6 h); or (iv) the combination of flurbiprofen and tramadol (as above). Pulpectomy combined with placebo medication resulted in a 50% reduction in pain by 24 h (p < 0.01). Patients treated with flurbiprofen and tramadol reported less pain, compared with placebo treatment at 6 and 24 h (p < 0.01 for both). These results suggest that a nonsteroidal anti-inflammatory drug/opiate combination, together with endodontic therapy, may be useful in the management of endodontic pain.

Analgesics, Opioid↗
PubMed1989

The intensive aspect of information processing in the intradental A-delta system in man--a psychophysiological analysis of sharp dental pain.

The tooth pulp has many attractive features for the study of peripheral pain mechanisms because of its rich innervation, its unique distribution of nerve fibers and its general disposition to give rise to pain upon stimulation. An experimental model has been developed for simultaneous recordings of intradental multi-unit A-delta nerve activity and the subjective intensity and quality of pain evoked by tooth pulp stimulation in conscious, alert humans. The only teeth to be considered for this kind of investigations are those having such a periodontal condition that they have to be extracted. The nerve activity was recorded from two electrodes placed in the dentin on the labial tooth surface, one at the level of the most incisal part of the pulp, and the other as far apically as possible. Brief cold stimulation was produced by using evaporating ethyl chloride administered between the recording electrodes. The magnitude of perceived pain was estimated by means of an intermodal matching technique (finger span) in combination with verbal descriptors. Of three response criteria selected--average response amplitude, peak amplitude and area under the response curve (integral)--for describing the relationship between intradental nerve activity and sharp, shooting pain, the integral yielded the highest mean correlation coefficient.

Adult↗
PubMed2000

[Aspirin, pain and inflammation].

SUBJECT: Acetylsalicylic acid (ASA) is among the most commonly analgesic, antipyretic and anti-inflammatory used drugs. The anti-inflammatory effects of ASA are mediated by the inhibition of cyclooxygenase enzymes with the subsequent decrease of prostaglandin synthesis. NEW DATA: However, since this discovery of Vane in 1971, much of other mechanisms of anti-inflammatory action, without relation with cyclooxygenases, have been proposed. ASA has peripheric analgesic properties by reducing prostaglandin biosynthesis. But there is evidence that the analgesic effects could be mediated by central mechanisms with changes in the monoaminergic and opioid systems. ASA is essentially used in moderate pains with an inflammatory component (rheumatological disorders, headaches, dental and postoperative pains). PERSPECTIVES: The clinical use of ASA at anti-inflammatory dose is less frequent because the other non steroidal anti-inflammatory drugs are as effective as ASA, but they are associated with less side effects. Nevertheless, the synergism of ASA and morphine association and the possible involvement of the central serotonergic and opiatergic systems in the antinociceptive activity of ASA could confer a greater role of ASA in pain management.

Adult↗
PubMed2003

The dental care pathway of welfare recipients in Quebec.

IN Quebec (Canada), the utilization of dental care services varies greatly from one social class to another: whereas the well-to-do visit the dentist often for check-ups, those most in need demonstrate a "wait-and-see" attitude. The objective of our research was to describe the dental care pathway of the underprivileged when confronted with symptoms, and to understand how this pathway might be interrupted and possibly lead to tooth extractions. We arranged 16 one-on-one interviews with adult Montrealers who had experienced a dental problem during the 12 months preceding the interview. These participants, 9 women and 7 men aged between 30 and 48, lived in great poverty: all were welfare recipients, and as such, enjoyed the benefits of a government programme that entitled them to free basic dental care. During the interviews, the interviewers asked the participants to describe their latest dental problem and their subsequent behaviour. The dental care pathway of our participants was characterized by a strategy of adapting to the symptoms. This process of adapting, which can last several months, is essentially an individual process in which the individuals often resort to self-medication to soothe their pain. They decide to visit a dentist when the pain is too great and self-medication is no longer effective. Once this decision is made, their dental care pathway may nevertheless be interrupted in two ways: first, in the failure to find a dentist, and second, later, in the failure to complete treatments that are not covered by the welfare program, such as endodontic treatment. The fragmented character of these dental care pathways refers us to two features of accessibility: financial accessibility and acceptability. With regard to financial accessibility, our study shows that the public coverage intended for welfare recipients presents major gaps. As for acceptability, our participants are strongly critical of the dental profession, and develop a culture of rejection of it.

Adult↗
PubMed1997

Early management of dental pain in children and adolescents.

OBJECTIVES: There is little information regarding the initial management of dental pain in children and adolescents. The present study investigated the early management of 155 children and adolescents with dental pain prior to definitive treatment in the Eastman Dental Institute and Hospital for Oral Health Care Sciences, London, UK. METHOD: Prior to the child being examined by a qualified dentist in the casualty department, the accompanying parents or guardians were requested to complete a self-administered questionnaire regarding the duration and severity of pain, presence of swelling, professional advice sought and medication taken. RESULTS: Of the attending children, 83% were in pain, 20% having been in pain for over 1 month. Most parents sought professional health care advice, particularly from a dentist; however, 15% initially obtained advice from a medical practitioner and 5% from a pharmacist. Simple analgesics were taken by 74% of patients; however, these rarely produced complete pain relief. Of concern, 10 children were inappropriately given aspirin, three of whom had taken the aspirin on the advice of a pharmacist. Sixty-seven children received systemic antibiotic therapy; however, 31% of these patients did not have any local swelling. CONCLUSION: It is evident that children and adolescents often receive inappropriate initial treatment for dental pain and may thus suffer unnecessary symptoms for several weeks. There is thus a need to educate healthcare workers more appropriately on aspects of the management of oral pain and to promote oral health care and hence reduce the incidence of caries in children.

Adolescent↗
PubMed1998

Postobturation pain after single- and multiple-visit endodontic therapy. A prospective study.

OBJECTIVES: This prospective study was conducted to determine whether there is any significant difference in the incidence of postobturation pain after single- and multiple-visit root canal treatment (RCT). METHODS: The frequency of postobturation pain was recorded and evaluated over an observation period of 30 days in 291 of 300 consecutive patients receiving RCT. The patients were assigned randomly and consecutively into either single- or multiple-visit groups. The canals of all teeth were prepared and filled by a single operator using the step-back and lateral condensation techniques. The data were analysed statistically to determine the relationship, if any, between the pain experienced and pulpal vitality, tooth type, pre-operative pain, and the sex and age of the patient. RESULTS: Nine of the 300 patients were excluded from the analysis as they failed to attend for postoperative reviews. A significantly higher incidence (P < 0.01) of postobturation pain was found in the multiple-visit group (38%) than in the single-visit group (27%) within 24 h of obturation. The incidence of pain decreased thereafter, with all patients being sysmptom free at the end of the observation period. No significant correlation was found between postobturation pain and any other factor, with the exception that teeth which had nonvital pulp prior to treatment were associated with a significantly greater (P < 0.005) incidence of postobutration pain. CONCLUSIONS: Pain was significantly higher in the multiple-visit RCT group and significantly associated with the treatment of the nonvital pulp.

Adolescent↗
PubMed1986

Elongated styloid process syndrome masquerading as pain of dental origin.

An elongated styloid process may be a source of craniofacial and cervical pain. This condition is characterized by a dull, nagging, pharyngeal pain and a palpatory finding in the tonsillar fossa. Sometimes the pain is localized, or radiates to the jaw and ear and may simulate pain of dental origin. Radiographic demonstration of styloid elongation is readily made in most instances. The only effective treatment is surgical shortening of the styloid process. Eight patients undergoing surgery for elongated styloids are reported. Six were previously treated under an incorrect diagnosis such as oral, dental or temporomandibular disease, and subsequently mostly inappropriate dental treatments and exodontia were performed. An evaluation of the intraoral versus the external approach is presented. The few and isolated reported cases of stylalgia masquerading as dental pain and the ensuing mistreatment warranted the writing of this paper.

Adult↗
PubMed1999

Relationship between a genetic predisposition to hypertension, blood pressure levels and pain sensitivity.

INTRODUCTION: The aim of this study was to determine whether the degree of blood pressure elevation and/or a genetic predisposition to hypertension have a major role in determining a reduced pain perception in hypertensives. The reasons underlying the relationship between blood pressure elevation and pain perception mechanisms are not completely understood. METHODS: One hundred and four untreated hypertensive patients (65 subjects with and 39 without a positive parental history of hypertension) together with a control group of 42 subjects (20 normotensive offspring of normotensive parents, and 22 normotensive offspring of hypertensive parents) were submitted to standard blood pressure evaluation, 24-h blood pressure monitoring and dental pain perception evaluation. RESULTS: Both pain threshold and tolerance were found to be higher in hypertensive than normotensive subjects (P < 0.0001 and P < 0.015, respectively). Positive significant correlations were found between both 24-h systolic and diastolic pressure and the pain perception variables. When a 2 x 2 ANOVA test was performed, factoring for the effects of both blood pressure status and family history of hypertension on pain sensitivity, a significant effect was revealed only for blood pressure status. Moreover, after controlling for blood pressure by a covariate analysis, no significant difference was found between the subjects with or without hypertensive parents as regards pain perception variables. CONCLUSIONS: Pain sensitivity is correlated to blood pressure levels whereas the parental history of hypertension per se does not affect the pain perception pattern. Thus, the degree of blood pressure elevation, more than a genetic predisposition to hypertension may influence the mechanisms leading to hypalgesia in hypertension.

Adult↗
PubMed1996

Distal movement of premolars to provide posterior abutments for missing molars.

In 24 patients with missing molar teeth in the upper and/or in the lower jaw, 32 premolars were distalized. The mean orthodontic distalizing distance was 9.4 mm (SD 2.6). After distalization all these teeth served as posterior abutments for fixed restorations. The investigation period ranged between 2.5 to 14.1 years, average 9.6 years (SD 3.2). The clinical examination criteria were sensitivity, mobility, probing depth, sulcus bleeding index; the radiologic criteria were root resorption (lateral and apical) marginal bone level and axial position. None of the 32 premolar abutments were lost during investigation period. All the teeth maintained their vitality. The measured probing depths and sulcus bleeding indices were low. Of the teeth tested 40.6% revealed localized lateral root resorption on the pressure side; the average postorthodontic depth of root resorption was 0.7 mm (SD 0.3), and the length 2.3 mm (SD 0.6). The follow-up examination revealed a partial repair of the lateral root lesions. The extent of apical root resorption amounted to 0.9 mm (SD 1.1). The marginal bone level showed a bone loss of 0.5 mm mesially and 0.2 mm distally. The findings confirm that the distalized premolar functioning as a posterior bridge abutment represents a prognostically favorable alternative to an implant.

Adolescent↗
PubMed2003

Postcementation hypersensitivity: scientific data versus dentists' perceptions.

PURPOSE: The purpose of this article was to obtain dentists' opinions via an Internet survey as to the prevalence, causes, and prevention of postcementation sensitivity and compare their responses with published data on the problem. MATERIALS AND METHODS: Information as to respondents opinions of postcementation sensitivity was obtained from an Internet survey asking about their experience and for a ranking of the importance of each of 15 factors. RESULTS: A total of 466 valid responses were received. The incidence of postcementation sensitivity was estimated to be less than 2% by more than 2/3 of the dentists. The factors considered "very important" in reducing sensitivity by more than 50% of the respondents were desiccation, luting agent, occlusion, provisional, and water spray. CONCLUSIONS: Comparing respondents' opinions with published clinical studies, the incidence of postcementation sensitivity appears to be underestimated. There is little published evidence to support the importance of antimicrobials, desensitizing, or bonding agents, although these are considered effective by some dentists. Many respondents consider luting agent to be an important variable.

Adult↗
PubMed2003

Clinical comparison of two self-directed bleaching systems.

PURPOSE: This randomized clinical trial compared the clinical efficacy and tolerability of 2 marketed self-directed vital tooth-whitening systems. MATERIALS AND METHODS: Balancing for baseline tooth color, self-reported coffee/tea use, and age, 57 adult volunteers were randomized to either a whitening strip containing 6% hydrogen peroxide or a tray-based 10% carbamide peroxide/dentifrice/mouth rinse combination system. Following the manufacturer's directions, the strip group bleached twice daily for 30 minutes, whereas the tray group bleached twice daily for 20-30 minutes, preceded by tooth brushing with a whitening dentifrice and followed by mouth rinsing with a whitening solution. Treatment extended for 14 days, with evaluation at day 7 and again at day 14. Whitening response was measured objectively as L*a*b* from standardized digital images of maxillary anterior teeth. Tolerability was assessed by oral examination and subject interview. Efficacy comparisons were made using analysis of covariance, whereas tolerability was compared using the nonparametric Wilcoxon rank-sum test. RESULTS: Both treatments resulted in statistically significant (P < 0.01) improvements from baseline for all color parameters. For between-group comparisons, the 6% hydrogen peroxide strips yielded a nearly 3-fold reduction in yellowness (deltab*), a nearly 2-fold improvement in lightness (deltaL*), 2.6 times greater redness reduction (deltaa*), and a more than 2-fold change in overall color (deltaE*) compared to the tray-based combination system. Between-group comparisons were statistically significant for the all color parameters at both the day 7 and day 14 evaluations (P < 0.001). In general, 7-day use of the whitening strips provided significantly greater color improvement relative to the combination dentifrice/gel/rinse system at day 14. In addition, the groups differed significantly (P < 0.05) in bleaching tolerability severity-days, with the strip system demonstrating better overall tolerability compared to the combination system. CONCLUSIONS: The single-step 6% hydrogen peroxide strips demonstrated better overall clinical response, in terms of both tooth-whitening efficacy and tolerability, than the multiple-step tray-based combination system.

Adolescent↗
PubMed2003

Comparison of preoperative pain and medication use in emergency patients presenting with irreversible pulpitis or teeth with necrotic pulps.

OBJECTIVE: This retrospective study compared differences in preoperative pain and medication use in patients with moderate to severe pain who sought emergency endodontic care for teeth with irreversible pulpitis and for symptomatic teeth with necrotic pulps. STUDY DESIGN: A total of 323 patients seeking emergency endodontic treatment completed questionnaires regarding their biographical information, pain, pain history, and medications. Teeth were tested for vitality, mobility, percussion, and palpation pain. Lymphadenopathy was also evaluated. RESULTS: Patients with irreversible pulpitis waited significantly (P <.05) longer before seeking emergency care (9 days vs 4 days) than patients with symptomatic teeth with necrotic pulps. No differences (P >.05) were found between the groups in terms of analgesic or antibiotic use and pain relief from preoperative narcotic medications. Nonnarcotic analgesics were reported to significantly reduce pain more often in patients with symptomatic teeth with necrotic pulps. There were sex differences in the group of patients with irreversible pulpitis: More women than men were taking analgesic medications and, in the group having symptomatic teeth with necrotic pulps, more men than women reported pain relief from their analgesic medications. CONCLUSION: Patients with irreversible pulpitis wait longer to seek emergency treatment. A majority (81%-83%) of emergency patients with moderate to severe pain will have taken some type of medication(s) to help control their pain, and more women than men with irreversible pulpitis will take an analgesic. By taking their preoperative medication(s), this group of patients will get relief 62% to 65% of the time; furthermore, more men than women with symptomatic teeth with necrotic pulps will experience pain relief.

Adult↗
PubMed1995

Herpes zoster infection presenting as an acute pulpitis.

A major reason for referral to an endodontic practice is management of pain. Most cases are diagnosed as being of pulpal or periapical origin. However, some turn out quite differently than their initial appearance. This case report presents a patient referred to the endodontic clinic because of symptoms mimicking an irreversible pulpitis. On examination no obvious cause of the symptoms could be found. The patient was treated conservatively after which a herpes zoster viral infection was diagnosed. This case stresses the importance of a thorough investigation of all signs and symptoms and the delay of definitive treatment until a diagnosis is made.

Acute Disease↗