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PubMed1990

Polyamine analysis of infected root canal contents related to clinical symptoms.

The contents of infected root canals were collected by mechanical and chemical debridement. Intracanal polyamines were identified and quantified by HPLC in all canals examined, however, no histamine was detected in any canal. The relationship between the amount of each polyamine and clinical signs of the teeth was analyzed statistically. The teeth without clinical signs tended to have limited varieties and smaller amounts of polyamines. Using chi 2, the amounts were significantly greater in teeth with spontaneous pain, swelling and putrescent odor (p less than 0.01), with exudate (p less than 0.025) and with percussion pain (p less than 0.1) than in teeth without. Amounts of putrescine (p less than 0.05) and total polyamines (p less than 0.01) were greater in teeth with spontaneous pain and percussion pain than in teeth without clinical sign, and those with root canal exudate also had greater amounts of total polyamines than those without (p less than 0.01). The amounts of cadaverine, however, from the teeth with gingival fistulae, was greater than from those without (p less than 0.05). No significant relationship was established between the amount of each polyamine and the presence of putrescent odor or gingival swelling. Intracanal polyamines, especially putrescine may leak out through apical foramen and may be implicated in pain production by eliciting acute inflammatory response in the periapical tissues.

Adolescent↗
PubMed1990

Relationship of intracanal medicaments to endodontic flare-ups.

The purpose of the study was to compare the effect of three intracanal medicaments on the incidence of post-instrumentation flare-ups. All teeth were instrumented to a predetermined minimum size using a 0.5% solution of sodium hypochlorite as the irrigant. Formocresol, Ledermix, and calcium hydroxide were placed in strict sequence irrespective of the presence or absence of symptoms or radiographic signs of apical periodontitis. The patients were given written post-operative instructions and a prescription for 600 mg ibuprofen to be taken if mild to moderate pain developed. If severe pain and/or swelling developed the patient was instructed to call the office immediately and was considered to have had a flare-up. Twelve flare-ups occurred in teeth with radiographic signs of apical periodontitis; none in teeth without periapical radiolucencies. Six of the twelve flare-ups occurred in retreatment cases and the other six occurred in teeth without previous endodontic treatment. No significant difference was found in the flare-up rate among the three intracanal medicaments.

Acute Disease↗
PubMed1994

Inflammation and dental pain in man.

In the present article special interest has been focused on indicators of latent and manifest pulpal inflammation studied by psychophysical and electrophysiological techniques. Intradental A-delta nerve activity was recorded from two electrodes placed in the dentin on the labial tooth surface. The psychophysical measures were obtained by means of direct scaling methods in combination with sensory verbal descriptors. For stimulation cooling (ethyl chloride) and heating (hot guttapercha) of the tooth surface were employed. In addition, potentially algogenic substances, bradykinin and histamine, were administered on partly exposed pulps. Hot guttapercha induced a more complex neural response pattern than ethyl chloride. In all the recordings the responses evoked by heat showed a characteristic pattern consisting of three phases: an initial phase of short duration (i) followed by a depression in activity relative to the baseline (ii) and a slow spontaneously emerging activity in the absence of a physical stimulus (iii). The latter neutral event (iii) passed unnoticed by all the subjects. In the light of earlier experiments on feline pulp it was hypothesized that this third phase of the neural response was an indication of hyperexcitability in dental pulps and thus inflammation. Those subjects who experienced pulsating, dull, lingering pain (clinically diagnosed as pulpitis) showed a poor correlation between magnitude estimates of their mixed pain percepts and the total flux of A-delta nerve activity. Bradykinin and histamine evoked dull pain in the majority of cases probably caused by excitation of pulpal C fibers. In one experiment A-delta neural discharge of short duration could also be triggered by histamine.(ABSTRACT TRUNCATED AT 250 WORDS)

Bradykinin↗
PubMed1994

Encoding of the subjective intensity of sharp dental pain.

This paper is a review and a discussion of our own pain research over the last decade. It is of a methodological and theoretical character and deals with preparation technique, choice of electrodes, control experiments involving pulpotomy and reliability tests of psychophysical methods for pain measurements, and the neuronal population encoding of sharp dental pain. The electrophysiological recording technique selectively picks up electrical activity induced in pulpal A-delta nerve fibers. The sensation of pain was quantified by means of an intermodal matching technique, finger span (PAS), in combination with sensory verbal descriptors covering a range from very, very weak to maximal pain. When a cold stimulus, ethyl chloride, was applied on the tooth surface a close agreement was demonstrated between intradental A-delta nerve activity (INA) and the sensation magnitude of pain (PAS) with respect to curve amplitude and time course. The high covariation of the neural and perceptual response measures indicated a good internal validity and confirmed also the basic soundness and the applicability of the procedures employed. For the purpose of further analyzing the functional relation of INA to PAS we studied specifically the effect of cold stimuli of different intensity on the integrated nerve response. Only sharp, shooting pain was accepted as a sensorial, perceptual correlate of the intradental A-delta nerve activity. Since an increase in amplitude was generally accompanied by an increase in duration of the responses, the fundamental question was raised how to best describe and characterize the neural and perceptual responses so that they most adequately reflect the information processing of the intensive aspect of sharp dental pain.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Immunoglobulins in periapical exudates of infected root canals: correlations with the clinical findings of the involved teeth.

This study quantified the concentrations of IgG and IgA in the periapical exudates obtained from 69 single-rooted teeth using enzyme-linked immunosorbent assays, and examined their correlation with clinical findings of the involved teeth. Changes in the levels of these immunoglobulins during root canal treatment were also investigated. The average levels of IgG (85.61 mg/ml) was significantly higher than that of IgA (0.65 mg/ml) (P < 0.001). The exudates from the canals with large lesions (> or = 1 cm in diameter on radiographs) showed significantly higher IgG and IgA levels than small lesions (< 1 cm in diameter) (P < 0.01). The tendency for these to be a decrease in the levels of IgG and IgA was observed following the root canal treatment. These observations suggest that IgG and IgA are involved in the immunopathogenesis of periapical lesions.

Bacterial Infections↗
PubMed1995

Dentists' views on cervical hypersensitivity and their knowledge of its treatment.

A random sample of 400 Dutch general practitioners was asked to complete a questionnaire dealing with the prevalence, conditions and therapies of cervical hypersensitivity of their patients. According to the 259 responding dentists an average of 10% of their patients suffered from moderate cervical pain. The estimated mode for severe pain was 1%. More than two thirds of the dentists reported inadequate brushing of the teeth to cause the hypersensitivity, about one half acknowledged periodontal causes, well over one quarter mentioned the involvement of dietary acids, and about one sixth implicated psychosomatic factors. Other causal factors were mentioned less often. Of the therapies available, the home-care methods appeared to be promoted most often, i.e. brushing with therapeutic toothpastes (77%), improvement of oral hygiene (51%) and local self-application (with finger) of a therapeutic toothpaste or fluoride preparations before the night (41%). Well over 50% reported to apply occasionally bondings/varnishes and 28% said to make sometimes cervical fillings. Other therapeutic possibilities were not, or very seldom, used.

Attitude of Health Personnel↗
PubMed1999

Pulpal ischemia in man: effects on detection threshold, A-delta neural response and sharp dental pain.

Preferential blocks of peripheral nerves have shown that myelinated nerves are more susceptible to local compression and less resistant to asphyxia than unmyelinated fibers. Since two groups of functionally different nociceptors exist in the dental pulp, it is of theoretical and clinical interest to determine the influence of ischemia on the sensitivity of human dental pulp, using standard means for testing tooth vitality and at the same time investigating the intensity coding in one pathway of the afferent trigeminal system. Adrenaline was used to study the differential effect of adrenaline-induced ischemia on intradental A-delta nerve activity (INA) and the concomitant sharp pain, as well as on the detection threshold for monopolar electrical stimulation. Cold (ethyl chloride) and heat (heated gutta-percha) stimulation was applied to the tooth surface. In accordance with the hydrodynamic theory of dentin sensitivity the rapid fluid flow induced in the dentinal tubuli by these thermal stimuli is an adequate stimulus for selectively activating the A-delta nerves in healthy pulps. Consistency plots of the magnitude of the perceptual experience of sharp pain against the neural population response in linear coordinates yielded a high product-moment correlation, implying linearity for the intensity coding relationship. In contrast to the significant reduction of INA and its perceptual correlate of sharp pain after adrenaline administration, the electrical detection threshold remained constant during the full test period, suggesting that electrical threshold measurements have their limitations as a diagnostic tool or criterion for assessing the sensitivity of the dental pulp. The absence of A-delta activity was parallelled by no sensation of sharp pain. These findings suggested that the integrated neural A-delta activity constituted the underlying peripheral neurophysiological mechanism of the sensory intensity of sharp dental pain.

Adult↗
PubMed1999

Post-operative symptoms and healing after endodontic treatment of infected teeth using pulsed Nd:YAG laser.

Forty-four teeth in 38 patients, diagnosed with chronic apical periodontitis, were endodontically treated. Root canals were shaped using a step-back technique with 5% NaOCl and 3% H2O2 as irrigants. In half of the teeth the canal terminus was irradiated with pulsed Nd:YAG laser (1 W, 15 pps, 1 s). All canals were then obturated with laterally condensed gutta-percha points and sealer, and final radiographs were obtained. Occurrence of spontaneous pain was recorded 1 day after treatment. Percussion pain was recorded after 1 week, and then at 3 and 6 months after treatment. Radiographic follow-up was performed at 3 and 6 months. Percussion pain was significantly less (P < 0.05) in the laser-treated group than in the control group, both 1 week and 3 months after treatment. Other differences between the groups were not significant. These results suggested that the clinical application of pulsed Nd:YAG laser might be advantageous for the treatment of infected root canals.

Adult↗
PubMed2004

Healing of 400 intra-alveolar root fractures. 1. Effect of pre-injury and injury factors such as sex, age, stage of root development, fracture type, location of fracture and severity of dislocation.

This retrospective study consisted of 400 root-fractured, splinted or non-splinted incisors in young individuals aged 7-17 years (mean = 11.5 +/- 2.7 SD) who were treated in the period 1959-1995 at the Department of Pediatric Dentistry, Eastman Dental Institute, Stockholm. Four hundred of these root fractures were diagnosed at the time of injury; and 344 teeth were splinted with either cap-splints, orthodontic appliances, bonded metal wires, proximal bonding with composite resin or bonding with a Kevlar or glass fiber splint. In 56 teeth, no splinting was carried out for various reasons. In the present study, only pre-injury and injury factors were analyzed. In a second study, treatment variables will be analyzed. The average observation period was 3.1 years +/- 2.6 SD. The clinical and radiographic findings showed that 120 teeth out of 400 teeth (30%) had healed by hard tissue fusion of the fragments. Interposition of periodontal ligament (PDL) and bone between fragments was found in 22 teeth (5%), whereas interposition of PDL alone was found in 170 teeth (43%). Finally, non-healing, with pulp necrosis and inflammatory changes between fragments, was seen in 88 teeth (22%). In a univariate and multivariate stratified analysis, a series of clinical factors were analyzed for their relation to the healing outcome with respect to pulp healing vs. pulp necrosis and type of healing (hard tissue vs. interposition of bone and/or PDL or pulp necrosis). Young age, immature root formation and positive pulp sensibility at the time of injury were found to be significantly and positively related to both pulpal healing and hard tissue repair of the fracture. The same applied to concussion or subluxation (i.e. no displacement) of the coronal fragment compared to extrusion or lateral luxation (i.e. displacement). Furthermore, no mobility vs. mobility of the coronal fragment. Healing was progressively worsened with increased millimeter diastasis between fragments. Sex was a significant factor, as girls showed more frequent hard tissue healing than boys. This relationship could possibly be explained by the fact that girls experienced trauma at an earlier age (i.e. with more immature root formation) and their traumas were of a less severe nature. Thus, the pre-injury or injury factors which had the greatest influence upon healing (i.e. whether hard tissue fusion or pulp necrosis) were: age, stage of root development (i.e. the size of the pulpal lumen at the fracture site) and mobility of the coronal fragment, dislocation of the coronal fragment and diastasis between fragments (i.e. rupture or stretching of the pulp at the fracture site).

Adolescent↗
PubMed1998

The use of acupuncture in dentistry: a review of the scientific validity of published papers.

OBJECTIVE: To review the scientific validity of published papers on the efficacy of acupuncture in dentistry based on predefined methodological criteria. MATERIALS: A literature search performed by the Royal Society of Medicine and the University Library, Copenhagen, Denmark was able to identify 74 papers written in English, German, Danish, Swedish, Norwegian, Italian, French and Russian published between 1966 and 1996. The search words were: acupuncture and electro-acupuncture, randomised controlled trials (RCT), dental pain, postoperative dental pain, painrelieving in dentistry, and dental analgesia. Among the 74 listed papers, 48 papers were reviewed in the following languages: English, Danish, Swedish, Norwegian and German. Fifteen papers were excluded because they were written in French, Italian or Russian; 11 papers were excluded because the abstract clearly indicated the paper was not a RCT or the paper was of a general nature without relevance to acupuncture. METHODS: To assess the methodological quality of the included papers, all papers were scored on the basis of predefined criteria. A total of 92 points could be achieved and on the basis of this scale papers were rated as: Excellent (85-100%), Good (70-84%), Fair (60-69%) and Bad (< 60%). MAIN OUTCOME: Fifteen out of 48 papers met the inclusion criteria. RESULTS: Only one study met the criteria with more than 85%. Five studies met the criteria with 70-84%. Three studies met the criteria with 60-69%. Six studies did not meet the criteria. Acupuncture in 11 out of 15 studies proved effective in the treatment of temperomandibular dysfunction (TMD) and as analgesia. Four studies showed no effect of acupuncture. CONCLUSION: The value of acupuncture as an analgesic must be questioned. The effect of acupuncture in treating TMD and facial pain seems real and acupuncture could be a valuable alternative to orthodox treatment.

Acupuncture Analgesia↗
PubMed2006

Parental oral health care of mentally retarded children in Ilala municipality, Dar es Salaam, Tanzania.

OBJECTIVE: The aim of this study was to investigate oral hygiene practices and oral health care given by parents to mentally retarded children in Dar es Salaam, Tanzania. METHODS: A total of 140 questionnaires were distributed; only 100 questionnaires were completed and thus were included in the analysis, a 71.4% response rate. Questionnaires inquired on oral hygiene practices, supervision or assistance during tooth brushing, examination of the oral cavity, and measures taken in an event of oral health problems. RESULTS: Sixty-five per cent of the children are able to brush their teeth, whereas 35% are brushed by a family member. About 74% of the children who brush themselves brush occasionally or once per day while 26% brush more than once per day. More than 58% of the children who brush themselves brush under supervision. A statistically significant difference was observed in respect of bleeding on brushing which was among 61% of the children who brush occasionally or once per day and among 29% of the children who brush more than once per day (Pearson chi2 = 5.13, P = 0.024). Sixty-four per cent of parents occasionally examine their children's oral cavity. Few parents take their children to a dentist in an event of toothache/cavity on a tooth (26%) or bleeding on brushing (37%). CONCLUSION: Most children are able to brush their teeth themselves. Majority of those who cannot brush are assisted. Bleeding on brushing and tooth cavities are common problems but few children are taken to a dentist for care.

Adolescent↗
PubMed2000

Reversible and irreversible painful pulpitides: diagnosis and treatment.

The foregoing clinical evidence indicates that when pain is severe, or when mild to moderate pain is present with a previous history of pain in the aching tooth, with or without periapical radiolucency, the tooth is in the IRPP category. Treatment dictates endodontic therapy or extraction. On the other hand, when clinical evidence indicates that the pain is mild or moderate with no previous history of pain, normal pulp vitality, and there is no positive percussion sign, the pulp is in the RPP category. Treatment dictates indirect or direct pulp capping in teeth with or without periapical radiolucency. The success rate favours teeth with no periapical radiolucency, 98%; in teeth with periapical radiolucency the success rate is less favorable, 43%. Efforts should be made to maintain pulp vitality. Endodontic therapy can always be done, if in time the pulp develops necrosis.

Adolescent↗
PubMed2000

Neuropathic orofacial pain part 1--prevalence and pathophysiology.

Neuropathic pain is defined as "pain initiated or caused by a primary lesion or dysfunction in the nervous system". Neuropathic orofacial pain has previously been known as "atypical odontalgia" (AO) and "phantom tooth pain". The patient afflicted with neuropathic oral/orofacial pain may present to the dentist with a persistent, severe pain, yet there are no clearly identifiable clinical or radiographic abnormalities. Accordingly, multiple endodontic procedures may be instigated to remove the likely anatomical source of the pain, yet the pain persists. There have been few studies and limited patient numbers investigating the condition. Two retrospective studies revealed the incidence of persistent pain following endodontic treatment to be 3-6% and 5% of patients; one author with wide experience in assessing the condition estimated its prevalence at 125,000 individuals in the USA alone. In one study, 50% of neuropathic orofacial pain patients reported persistent pain specifically following endodontic treatment. Patients predisposed to the condition may include those suffering from recurrent cluster or migraine headaches. Neuropathic pain states include postherpetic neuralgia (shingles) and phantom limb/stump pain. The aberrant developmental neurobiology leading to this pain state is complex. Neuropathic pain serves no protective function, in contrast to physiological pain that warns of noxious stimuli likely to result in tissue damage. The relevant clinical features of neuropathic pain include: (i) precipitating factors such as trauma or disease (infection), and often a delay in onset after initial injury (days-months), (ii) typical complaints such as dysaesthesias (abnormal unpleasant sensations), pain that may include burning, and paroxysmal, lancinating or sharp qualities, and pain in an area of sensory deficit, (iii) on physical examination there may be hyperalgesia, allodynia and sympathetic hyperfunction, and (iv) the pathophysiology includes deafferentation, nerve sprouting, neuroma formation and sympathetic efferent activity.

Cluster Headache↗
PubMed2000

Selective and intelligent use of antibiotics in endodontics.

Antibiotics have been used extensively for the management of odontogenic infections since their discovery early this century. Although they have been invaluable in the management of acute and severe infections, many members of the dental and medical professions have unfortunately used these drugs inappropriately for the management of dental pain when "local" dental treatment would have sufficed. This, and the general over-use of antibiotics in other situations such as for growth enhancement in animals for human consumption, is leading to the widespread development of strains of bacteria that are resistant to antibiotics--hence, their effectiveness is being reduced at a rapid rate. The dental profession has a responsibility to patients and to the community as a whole to restrict the use of antibiotics to those situations that actually require them. This philosophy should also be extended to other professions who may be called upon to manage dental pain at times.

Agrochemicals↗