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PubMed2002

The diagnosis of referred orofacial dental pain.

Every patient's description of the location of pain must be treated with caution. In order to arrive at a diagnosis of pain a logical method should be employed. This consists of the history and clinical examination including pulp tests and radiographs. Where the patient complains of pain on hot or cold, an attempt should be made to reproduce the patient's pain to check on the accuracy of its description and to aid in localisation. Patients frequently refer pain to previously endodontically-treated teeth. These may not be the cause of the problem. In order to facilitate the process of diagnosis the following hypothesis has been advanced. A tooth can only be the source of pain if there are objective signs associated with that tooth. Lack of response to pulp tests constitutes such a sign, provided the tooth has not previously been endodontically treated. If, however, such treatment has taken place, (regardless of whether this was well or poorly executed), a further objective sign other than lack of vitality is required before such a tooth can be implicated as the source of pain. The guidelines suggested are illustrated by means of clinical examples.

Adult↗
PubMed2005

Relationship of patient complaints and signs to histopathologic diagnosis of pulpal condition.

The correlation between the histopathologic examination of pulp biopsy specimens and patients' complaints and signs was investigated. The sensitivity, specificity and reliability of each complaint and sign, and the characteristics of pain that are associated with treatable and untreatable pulp states is proposed. Pulp specimens were obtained from teeth that required endodontic treatment. Clinical data were recorded to identify each patient's complaints. The pulp specimens were processed and the histopathologic diagnoses were categorised and correlated with the patients' complaints. Of the 240 cases, 100 (41.7%) were diagnosed as atrophic pulp or pulposis; 4 (1.7%) as acute pulpitis; 64 (26.7%) as transitional stage; 56 (23.3%) as chronic pulpitis, and 16 (6.7%) as acute pulpitis superimposed on a chronic pulpitis. Results showed that previous pain (p < 0.05), spontaneous pain (p < 0.01), and prolonged pain on cold stimuli (p < 0.05), were significantly more frequent in the patients with chronic pulpitis compared to those with pulposis or transitional stage. We concluded that clinicians must consider the sensitivity and specificity of patient complaints and signs in order to perform a diagnosis based upon clinical evidence.

Acute Disease↗
PubMed2005

Comparing the quality of anaesthesia in normal and inflamed teeth by pulp testing.

Failure to achieve complete anaesthesia of teeth with acutely inflamed pulps is a well-known clinical symptom. In this study, we compared the quality of anaesthesia in intact and inflamed mandibular teeth by using an electric pulp tester. Thirty patients with inflamed lower teeth, which had spontaneous or night pain, were selected; two healthy teeth in the same quadrant were used as control teeth. Electric pulp testing and thermal tests were made on each inflamed and control tooth. Teeth were then anaesthetised by inferior alveolar nerve block and electric pulp tests were repeated on inflamed and control teeth. Significant differences were found between electrical stimulation of inflamed and intact pulp (p approximately 0). There was no significant difference between the responses of inflamed teeth to electric pulp testing before and after anaesthesia (p = 0.327), which showed that the teeth could become resistant to anaesthesia due to the inflammation.

Anesthesia, Dental↗
PubMed1982

Effects of conditioning vibratory stimulation on pain threshold of the human tooth.

The effect of mechanical vibratory stimulation on the human tooth pain threshold has been studied in 4 healthy naïve subjects. Vibration at 10 and 100 Hz was applied to a maxillary incisor and the electrical pain threshold was measured in an adjacent tooth. During the conditioning stimulation the pain threshold increased 1.2-1.8 times the unconditioned values. The present study indicates that mechanical vibratory stimulation applied to human teeth elevates the pain threshold in adjacent teeth.

Adult↗
PubMed1993

Oral signs, symptoms, and behaviors in older Floridians.

Six hundred community-dwelling older Floridians were interviewed regarding the presence of reported signs of dental conditions, dental and oral symptoms, behavioral impact from dental conditions, and orofacial sensory changes. The prevalence of any single oral sign, symptom, or behavioral impact was generally low. A notable exception was the 39 percent prevalence of dry mouth. However, from 10 percent to 29 percent of persons had at least one of these dental signs, dental symptoms, dental behavioral impacts, or sensory changes. These findings are consistent with a noteworthy burden from nonoptimal oral health status, and these burdens were significantly more prevalent in irregular dental attenders, persons with lower household incomes, and persons who reported poorer general health. Inclusion of these non-disease items in an assessment of oral health status seems warranted, and would allow a broader evaluation of oral health outcomes.

Aged↗
PubMed1998

Oral functional limitation among dentate adults.

OBJECTIVES: The purpose of this study was to measure the prevalence of oral functional limitation in adults and to identify clinical and sociodemographic factors associated with that limitation. METHODS: The Florida Dental Care Study is a longitudinal study of risk factors for changes in oral health. Subjects (n = 873) with at least one tooth who were 45 years old or older participated in a baseline in-person interview and dental examination. Subjects were queried about oral functional limitations. RESULTS: Twenty-three percent of subjects reported difficulty chewing one or more foods using a five-item chewing index, and 10 percent reported difficulty speaking or pronouncing words because of problems with the mouth. The covariates in a multiple logistic regression identified as being significantly associated with chewing difficulty were fewer pairs of occluding anterior teeth, fewer pairs of occluding posterior teeth, more posterior teeth that are root tips, more anterior teeth that are mobile, reporting tooth pain, reporting bad breath, having but not wearing prosthetic appliances, reporting dry mouth, and being female. Having fewer anterior teeth, reporting a sore and/or broken denture, reporting unattractive teeth, and being black were significantly associated with speaking difficulty/difficulty pronouncing words because of problems with the teeth, mouth, or dentures. CONCLUSIONS: The findings in this study suggest a significant prevalence of oral functional limitation in dentate adults. Certain clinical and sociodemographic factors were strongly and independently associated with its presence.

Aged↗
PubMed2002

Racial and socioeconomic disparities in oral disadvantage, a measure of oral health-related quality of life: 24-month incidence.

OBJECTIVES: This paper estimates the incidence of oral disadvantage based on the subject's approach to dental care, sex, race, and financial status; identifies demographic and socioeconomic characteristics that were associated with oral disadvantage; and determines if these characteristics were differentially associated with the three domains of oral disadvantage. METHODS: The Florida Dental Care Study was a longitudinal study of oral health in diverse groups of persons who at baseline had at least one tooth, were 45 years or older, and were either African American or non-Hispanic white. Incidence rates, odds ratios, and 95 percent confidence intervals were used to describe oral disadvantage and its relation to race, income, and other key sociodemographic characteristics. RESULTS: The strongest independent predictors of oral disadvantage were approach to dental care (problem-oriented attenders or regular), and situation if faced with an unexpected $500 dental bill. Demographic and socioeconomic characteristics were differentially associated with each disadvantage domain. CONCLUSIONS: African Americans, females, rural residents, individuals who did not graduate from high school, individuals with limited financial resources, and problem-oriented dental attenders had significantly higher occurrences of oral disadvantage. Racial and sex disparities in oral disadvantage were largely explained by differences in approach to dental care and financial resources between these groups.

Black or African American↗
PubMed2003

Socioeconomic and demographic disparities in symptoms of orofacial pain.

OBJECTIVES: The purpose of this study was to document the association between socioeconomic status (SES) and the prevalence and impact of orofacial pain by anatomical location. In addition, differential effects of SES on orofacial pain across levels of sex, race, and age were documented. METHODS: The subjects were 724 participants in the Florida Dental Care Study, a study of oral health among dentate adults, aged 45 years and older at baseline. Pain prevalence and subjective ratings were assessed for a range of orofacial pain sites using a standardized telephone interview. RESULTS: Lower SES was associated with reporting pain and pain impact at many, but not all, of the orofacial sites. Some sex, race, and age cohort differences in orofacial pain were found when adjusting for differences in socioeconomic position. The most consistent result, as evidenced by similar findings across orofacial pain sites, was that the effects of SES on orofacial pain appear to have a sex-differentiated effect. CONCLUSION: Consistent with findings for other subjective measures of oral health, persons of lower SES are at increased risk for orofacial pain and pain-related behavioral impact.

Age Factors↗
PubMed2004

Validation of a Hebrew version of the Oral Health Impact Profile 14.

OBJECTIVE: This study determined the validity of a Hebrew version of the Oral Health Impact Profile in a cross-sectional study of a general dental practice in Israel. METHODS: The original English version of a short-form oral health impact profile (OHIP-14) was translated into Hebrew using the back-translation technique. Participants were interviewed and examined clinically by a calibrated dentist. Information on the subjects' sociodemographic background and oral health conditions was collected. RESULTS: A total of 142 persons were interviewed and clinically examined. The Cronbach's alpha and the standardized item alpha for OHIP-14 were both 0.88. Cronbach's alpha of the translated OHIP-14 subscales ranged from 0.48 to 0.76. Construct validity of the translated Hebrew version was supported by the finding that the total OHIP score correlated with the number of decayed teeth, missing teeth, need for prosthodontic treatment, and pattern of dental attendance. Participants with oral pain were more likely to report impact on one of the OHIP subscales and to have more impacts than participants who were pain free. CONCLUSIONS: The Hebrew version of OHIP-14 presented acceptable validity and reliability. Further research is needed to assess the value of this measure in Israel.

Adult↗
PubMed2005

Dental pain in Maryland school children.

OBJECTIVE: To describe the lifetime prevalence of dental pain among Maryland's school age children. METHODS: Data come from the Survey of Oral Health Status of Maryland School Children conducted in 2000-01. History of dental pain, as reported by an adult respondent, was analyzed for 2,411 kindergarten and third grade students. Percentages with their 95% confidence interval were calculated to obtain state representation of the distribution of dental pain by sociodemographic characteristics and caries status. RESULTS: Overall, 11.8 percent of Maryland school age children in kindergarten and third grade have had some dental pain. Among children who have had caries, the report of dental pain increases to 28.2 percent. Children from families with low educational attainment or eligible for free or reduced meals or covered by Medicaid were more likely to have experienced dental pain. CONCLUSION: Almost a third of Maryland kindergartens and third graders who have caries have experienced dental pain.

Child↗
PubMed2006

Predictors of dental pain and general anesthetic receipt for hospital dental procedures among New Zealand children.

OBJECTIVES: To predict experience of dental pain and hospital dental general anesthetic receipt among Mäori, Pacific and New Zealand European or Other (NZEO) children in New Zealand. METHODS: Data were from the 2002 National Child Nutrition Survey. Models representing demographic, socio-economic status (SES), lifestyle, dietary, food security and oral health paradigms were tested using logistic regression. RESULTS: Some 3275 children participated; 37.4% Mäori, 32.3% Pacific and 30.3% NZEO. Mäori children had higher odds of dental pain experience than NZEO children after adjusting for age, sex and length of time lived in New Zealand and with addition of household SES or physical factors. There were no differences in Pacific and NZEO child dental pain experience when the same factors were accounted for. The prevalence of dental general anesthetic receipt was similar among Mäori, Pacific and NZEO children after adjusting for demographic, lifestyle, dietary, food security and dental factors in separate models. When such factors were investigated together, Pacific children were less likely to have received a dental general anesthetic than NZEO children. CONCLUSIONS: Mäori children were more likely to experience dental pain and Pacific children were less likely to have received a dental general anesthetic than NZEO children after accounting for various behavioral and material factors. The latter may reflect issues pertaining to access and culturally insensitive services rather than demand for care per se.

Adolescent↗
PubMedDate not supplied

A prospective survey of hospital ambulatory dental emergencies. Part 1: Patient and emergency characteristics.

Part 1 of this study describes the dental disorders and patient characteristics of 253 patients who presented as dental emergencies to the University Hospital dental clinic, Vancouver, BC, during a three-month period. Most patients had a true perception of what constitutes a dental emergency. Dental pain was the predominant reason for seeking help, and the pain existed for more than seven days prior to contact in more than 50% of patients. Patients were not always able to identify the number and location of painful teeth, and a perceived low cost for treatment was a major reason for contacting the hospital. Reliability of emergency patients in keeping scheduled appointments was very high. Almost 69% of patients did not see a dentist regularly. Referrals to the hospital dental service were most numerous in the summer months. Diagnosis of the complaints revealed infection to be the cause of pain in 76.7% of patients.

Adolescent↗
PubMedDate not supplied

A prospective survey of hospital ambulatory dental emergencies. Part 2: Follow-up to emergency treatment.

Two hundred and fifty-three patients treated for dental emergencies at the University Hospital dental clinic over a three-month period were surveyed by telephone 24 to 48 hours and one year after treatment. The purpose was to investigate the success of treatment in resolving the chief complaint of pain and to determine the compliance with further dental care for the original dental problem. The results of the telephone survey showed that: patients available for questioning totaled 49.1% at 24 to 48 hours and 28.9% at one year; an 80.7% success rate was recorded in resolving pain within 24 to 48 hours; and the original emergency problem did not motivate a large number of these patients to seek further dental care.

British Columbia↗
PubMedDate not supplied

Coping with tooth pain: a qualitative study of lay management strategies and professional consultation.

This research analyzes transcripts of semi-structured interviews with patients presenting with tooth pain at a rural dental clinic in North Florida. The primary objectives are to identify the strategies patients use to manage their pain and to elucidate the decision-making process leading to the clinic visit. Although respondents understood that their condition was not self-limiting, only about one-half contacted the clinic within several days of the onset of their pain. Most tried one or more lay management strategies.

Activities of Daily Living↗
PubMedDate not supplied

Priorities for oral health goals in a sample of older adults.

This study was conducted to identify oral health factors that are important to people who are elderly. By identifying factors valued by patients who are older, dental professionals can gain better insights into the preferences and priorities that patients use in making dental treatment decisions. To determine which factors are important to this population, we compiled a list of oral health goals identified through a literature review. To supplement this initial list, we undertook line-by-line (open) coding of transcripts of two sets of semi-structured interviews. The first set of interviews explored the decision of older adults to seek treatment in response tooth pain. The second set of interviews elicited anticipated responses to three scenarios involving extensive restoration and one scenario involving extraction and prosthetic replacement among older patients at a dental school.

Age Factors↗
PubMedDate not supplied

Oral hygiene and oral symptoms among the elderly in long-term care.

Dental teams examined 1910 elderly adults living in long-term care settings (1358 institutionalized, 552 homebound) from all 19 counties in Norway to document oral hygiene, oral symptoms and ability to receive dental treatment. The Mucosal-Plaque Score (MPS) was used to assess oral status. The MPS was significantly better in women than in men, in individuals with dentures than in those with any remaining teeth, and in people who were homebound rather than those who lived in institutions. The MPS did not differ between age groups or geographic regions. According to the Treatment Ability Index, nearly a quarter of the sample was able to receive comprehensive dental care. Reports of "any oral symptom" and "eating/chewing problems" decreased with age and were most prevalent for individuals who had dentures. The MPS had only slight impact on oral symptoms, chewing ability and dry mouth (p > 0.05). Dry mouth was found in 16.9% and was most prevalent in individuals with dentures.

Aged↗
PubMedDate not supplied

Perceived need for dental care among dentate older individuals in Sri Lanka.

The authors assessed the perceived need for dental care among 585 older individuals, of whom 235 received a clinical oral examination. Of the 235 participants, only 171 were dentate. The present analysis is limited to this group. Of these 171 dentate adults, 43 percent perceived a need for dental care. Of this sample section, 53 percent perceived a need for dentures. Age, perceived oral health status, presence of mobile teeth, three impact items of the Oral Health Impact Profile-14 (OHIP-14) scale--namely "had a painful aching in the mouth, had difficulty in eating and that the diet had been unsatisfactory due problems with teeth, mouth or dentures"--and the total OHIP-14 score showed significant associations with perceived need for dental care in bi-variate analysis. Poor perceived oral health status emerged as the strongest predictor of perceived need for dental care in logistic regression.

Aged↗
PubMedDate not supplied

Dental care management of a young patient with extensive lymphangioma of the tongue: a case report.

Lymphangiomas are benign tumors resulting from a congenital malformation of the lymphatic system. Relatively uncommon, lymphangiomas are usually diagnosed at birth and develop within the first years of life. When these tumors occur in the oral cavity, the tongue is the most frequently affected site. Lymphangioma of the tongue is a common cause of macroglossia in children, which may lead to a dry/cracked tongue with ulcerating secondary infections, difficulty in swallowing and mastication, speech disturbances, exclusive nasal breathing, airway obstruction, mandibular prognathism and other possible deformities of maxillofacial structures. This paper discusses the most relevant features, clinical manifestations, disease-related impairments and treatment options for lymphangioma of the tongue. It presents the case report of a five-year-old child diagnosed with this lesion, including a description of the patient's dental care management.

Child, Preschool↗