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PubMed1996

Identifying acute pulpalgia as a factor in TMD pain.

An acute pulpalgia and temporomandibular disorders can produce many of the same symptoms. To illustrate identification of an acute pulpalgia as a component in TMD, the authors review the evaluation of 11 patients at a clinic that specializes in TMD treatment. During the evaluation, thermal testing and periodontal ligament anesthesia were used to identify the offending tooth. After receiving endodontic treatment or having the tooth extracted, patients reported either complete or partial relief of TMD symptoms. The authors provide questions that may help practitioners identify a tooth with an acute pulpalgia as a contributing factor to TMD symptoms and suggest a technique to confirm this diagnosis.

Acute Disease↗
PubMed1998

Synthetic hair braid extension artifacts in panoramic radiographs.

The authors present two case reports that illustrate synthetic hair braid extension artifacts in panoramic radiographs. They found that hairstyles using synthetic hair braid extensions created radiopaque patterns that varied according to hairstyles. They discuss how these hair extensions may affect panoramic radiographs and the importance of determining whether patients are wearing synthetic hair braid extensions.

Adult↗
PubMed1999

Chief complaints of patients seeking treatment for periodontitis.

BACKGROUND: Hardly any data are available concerning the chief complaints, or CCs, of patients with periodontitis. The authors conducted a study to determine the most common CCs among a group of subjects with periodontitis. METHODS: The authors examined the dental records of 191 patients with periodontitis to determine what CCs they orally reported having at an initial examination. Patients were referred mainly by other members of the dental health team. Eighty percent of the patients were diagnosed with moderate or moderate-to-severe periodontitis. The authors recorded the frequency of different CCs to determine the most common complaints. RESULTS: The authors recorded 336 CCs from the records of 191 subjects with periodontitis. There were 21 different CCs. The most common CC reported was, "I was told I have gum disease." The second most common CC reported was, "I would like to save my teeth." Neither of these CCs are true periodontitis symptoms. Bleeding gums--a true periodontitis symptom--was the third most common CC. Only 6.2 percent of the subjects reported having painful gingiva, and only 29.3 percent of the subjects reported having dental-emergency-related CCs. CONCLUSIONS: The authors found that the motivation to seek periodontal treatment was most commonly based on information given to the subjects by a member of the dental health team, rather than a periodontitis symptom. CLINICAL IMPLICATIONS: Renewed efforts and increased responsibility of the dental health team members to inform patients about the presence of periodontitis are needed, as well as emphasizing to the public the risk of losing teeth as a result of periodontitis.

Adolescent↗
PubMed1999

Pain after periodontal scaling and root planing.

BACKGROUND: Although periodontal scaling and root planing, or SRP, is one of the most common procedures used in dental practice, there is little information available about the degree of postprocedural pain associated with it. The authors undertook this study to document the intensity and duration of pain after SRP with a view toward helping practitioners and their patients manage postprocedural discomfort. METHODS: Using the Heft-Parker self-assessment pain scale, 52 adults with moderate periodontitis evaluated their pain before and after SRP conducted with local anesthetic. RESULTS: After SRP, 28 percent of all patients reported faint-to-weak pain, 18 percent experienced weak-to-mild pain, 28 percent experienced mild-to-moderate pain, 8 percent had moderate-to-strong pain and 8 percent reported strong-to-intense pain. The average time to onset of maximum pain was approximately three hours after SRP, and the average duration of mild or greater pain was about six hours. Upon awakening the morning after SRP, subjects found that pain had returned to pre-SRP levels. Overall, 23 percent of all patients reported self-medicating with analgesics to relieve postprocedural pain. Women self-medicated earlier (P < .05) and more often than men (43 percent vs. 10 percent; P < .05). CONCLUSIONS: Patients experienced significant duration and magnitude of pain after SRP. This pain peaked between two and eight hours after SRP, lasted about six hours, and returned to pre-SRP levels by the morning after the procedure. Almost 25 percent of all patients self-medicated to relieve pain after SRP, and women took analgesic medication earlier and more often than men. CLINICAL IMPLICATIONS: Practitioners should consider using appropriate analgesic drugs to alleviate mild-to-moderate pain after SRP. On the basis of this study, it would appear that an analgesic that has a peak effect two to eight hours after the completion of SRP would be the most appropriate medication. Moreover, it is unlikely that analgesic medication would be needed by most patients beyond the day on which SRP was performed.

Adolescent↗
PubMed2000

A clinical evaluation of 10 percent vs. 15 percent carbamide peroxide tooth-whitening agents.

BACKGROUND: Agents with carbamide peroxide, or CP, in various concentrations are widely prescribed for at-home tooth whitening. It is not clear, however, if the more concentrated gels will whitening teeth to a greater extent, as no controlled clinical trials have been reported. The authors conducted a double-blind study of human subjects to evaluate whether a 15 percent CP tooth-whitening system was more effective than a 10 percent CP system, and to determine if tooth sensitivity increased with use of the higher concentration. METHODS: The authors recruited 57 subjects with maxillary anterior teeth of shade A3 or darker (as gauged against a value-oriented shade guide). The subjects were 18 to 65 years of age and in good general and dental health. After matching the subjects by sex and age, the authors randomly assigned them to either a control group, which used a 10 percent CP whitening agent, or an experimental group, which used a 15 percent CP agent. RESULTS: The results indicated that there was no significant difference in shade change between the groups after one week of treatment (t = 1.455, P = .05), but there was a significant difference at the end of the treatment period (t = 2.303, P < .05), as well as two weeks after treatment concluded (t = 2.248, P < .05). There was no significant difference in sensitivity (t = 1.399, P > .05). CONCLUSIONS: There was a significant difference in color change between the 10 percent CP and 15 percent CP groups at the end of the study period. There was no significant difference in level of tooth sensitivity between the two groups, and the incidence was equal; there was, however, a significant difference in variability of tooth sensitivity between the two groups. CLINICAL IMPLICATIONS: If performed under the careful guidance of a dentist, at-home whitening is an effective treatment, regardless of whether 10 percent CP or 15 percent CP is used. There may be added color change and varying sensitivity with the use of 15 percent CP.

Adolescent↗
PubMed2000

Efficacy of bonded and nonbonded amalgam in the treatment of teeth with incomplete fractures.

BACKGROUND: This clinical study compared the efficacy of adhesive-retained vs. pin-retained complex amalgam restorations in the treatment of molars with incomplete fractures. Both relief of chewing pain and cold sensitivity were evaluated at two weeks, three months and one year. METHODS: The authors treated 38 patients with a chief complaint of chewing sensitivity on vital molar teeth (40 teeth in the study). A random-number generator determined the treatment method for each tooth. Twenty teeth received bonded amalgam restorations. Twenty teeth received amalgapins or threaded pins to retain the amalgam. Teeth were evaluated for postoperative chewing sensitivity. A visual analog pain scale was used to evaluate cold response to a skin-refrigerant-soaked cotton pellet at each visit. After 12 months, all 40 teeth were available for evaluation. RESULTS: Chewing pain was completely eliminated in all but one tooth. A Student's t-test found no significant difference (P > .05) in preoperative cold sensitivity between the bonded and nonbonded groups. A paired t-test comparison indicated that the teeth in the bonded group were significantly less sensitive to cold after three months and 12 months than they were at the time of the baseline measurements (P < .0001). A paired t-test indicated no significant difference between preoperative and postoperative cold sensitivity scores for teeth in the nonbonded group (P > .05). CONCLUSIONS: Both adhesively bonded and mechanically retained complex amalgam restorations were successful in resolving chewing sensitivity in cracked molars. For 39 of 40 teeth, chewing sensitivity did not return during the one-year follow-up period. At three months and 12 months, cold sensitivity was reduced in the bonded restorations. At all three time periods, cold sensitivity remained similar to baseline levels for the mechanically retained restorations. CLINICAL IMPLICATIONS: Incomplete tooth fracture in molars can be successfully treated by covering fractured cusps with amalgam restorations. This study excluded teeth with prolonged sensitivity to a cold stimulus or those with periodontal evidence of root fracture. With these exclusions, elimination of chewing sensitivity was predictable. Teeth restored with bonded restorations experienced a decrease in sensitivity to a cold stimulus at three months and at 12 months, but not at two weeks. The cold sensitivity of teeth restored with nonbonded restorations was similar at baseline, two weeks, three months and one year.

Adult↗
PubMed2000

Referred craniofacial pain patterns in patients with temporomandibular disorder.

BACKGROUND: Referred pain is prevalent in the craniofacial region, and it would be helpful for dental practitioners to have drawings delineating regions with a high probability for a patient's referred pain source. METHODS: The author applied firm pressure for approximately five seconds to trigger points, nodules of spot tenderness, and selected masticatory structures within the head and neck region on 230 patients with temporomandibular disorder, or TMD. As firm pressure was being applied, subjects were asked whether pain was developing or intensifying in a location different than that being palpated. RESULTS: One hundred ninety-six subjects (85 percent) reported that referred pain was being generated. The cheek area, ear and forehead were the most frequently reported sites of referred pain generation; palpation over the trapezius muscle, lateral pterygoid area and masseter muscle were the most common sources of referred pain to the craniofacial region. The author provides figures displaying common referred pain sites and their sources. CONCLUSIONS: Patients with TMD often report referred craniofacial pain arising from palpation of the head and neck region. The author found that the pattern between referred pain source and site was consistent and predictable. PRACTICE IMPLICATIONS: Practitioners should consider craniofacial pain's propensity for referral when treating patients with TMD. Practitioners can use the figures presented to determine regions of high probability for a patient's referred pain source.

Adolescent↗
PubMed2003

The effect of diabetes mellitus on endodontic treatment outcome: data from an electronic patient record.

BACKGROUND: The authors used a custom-built electronic record system to investigate endodontic diagnostic and treatment outcome data in patients with and without diabetes. METHODS: The medical histories and endodontic treatment data for nonsurgical endodontic patients treated in predoctoral and postgraduate specialty clinics were entered into an electronic record system. A total of 5,494 cases (including 284 cases in patients with diabetes) were treated, and 540 cases (including 73 cases in patients with diabetes) had follow-up data two years or more postoperatively. The authors performed univariate and multivariate analyses to determine important factors affecting endodontic diagnosis and treatment outcome. RESULTS: Patients with diabetes had increased periodontal disease of teeth with endodontic involvment compared with patients who did not have diabetes. There was a trend toward increased symptomatic periradicular disease in patients with diabetes who received insulin, as well as flareups in all patients with diabetes. Two years or longer postoperatively, 68 percent of cases followed were successful. Older age, the absence of preoperative lesions, the presence of permanent restorations and longer postoperative evaluation periods all were associated with a successful outcome. A multivariate analysis showed that in cases with preoperative periradicular lesions, a history of diabetes was associated with a significantly reduced successful outcome. CONCLUSIONS: Patients with diabetes have increased periodontal disease in teeth involved endodontically and have a reduced likelihood of success of endodontic treatment in cases with preoperative periradicular lesions. CLINICAL IMPLICATIONS: Patients with diabetes who are treated endodontically should be assessed carefully and be treated with effective antimicrobial root canal regimens, particularly in cases with preoperative lesions.

Acute Disease↗
PubMed2005

Spontaneous dissection of the internal carotid artery manifesting as pain in an endodontically treated molar.

BACKGROUND: Dental pain is a common occurrence, whereas spontaneous dissection of an internal carotid artery is rare. CASE DESCRIPTION: The authors describe a patient who experienced a spontaneous dissection of an internal carotid artery that manifested initially as dental pain in an endodontically treated molar. CLINICAL IMPLICATIONS: It is important for dental practitioners to be familiar with unusual causes of dental pain. In this case in which the cause of dental pain was uncommon, the authors referred the patient appropriately, thus avoiding potentially serious complications.

Carotid Artery, Internal, Dissection↗
PubMed2006

Odontogenic signs and symptoms as predictors of odontogenic infection: a clinical trial.

BACKGROUND: The authors conducted a study to determine if odontogenic signs and symptoms in the emergency department predicted the development of overt odontogenic infection at a follow-up dental visit. METHODS: One hundred ninety-five patients with odontalgia, but without overt signs of infection, were enrolled in a prospective, double-blind, randomized clinical trial. Data included dental diagnosis, pain characteristics, presence of caries and restorations, presence and size of periapical radiolucencies and other diagnostic test results. RESULTS: Thirteen of 134 subjects for whom data were available had signs of infection at the follow-up visit. Subjects in the follow-up infected (FU-I) group had larger baseline radiolucencies than did subjects in the follow-up noninfected (FU-NI) group, and restorations were more prevalent for involved teeth in the FU-I group than in the FU-NI group. CONCLUSIONS: A relationship exists between radiolucency size and the presence of amalgam restorations in patients who develop clinical signs of infection. Penicillin did not appear to influence this progression. CLINICAL IMPLICATIONS: Antibiotics are not effective in preventing the development of odontogenic infection when definitive dental therapy cannot be provided for acute pain in the absence of clinical signs of infection. Although the overall risk of developing infection is low, early treatment is indicated for teeth with larger periapical radiolucencies, amalgam restorations or both.

Abscess↗
PubMed2006

The use of COX-2 inhibitors for acute dental pain: A second look.

BACKGROUND: On the basis of their perceived better safety profile compared with other analgesic agents, cyclo-oxygenase-2 (COX-2) inhibitors have been prescribed frequently as first-line agents to treat acute dental pain. However, recently identified cardiovascular adverse reactions associated with these drugs mandate a reappraisal of their use in dental practice. TYPES OF STUDIES REVIEWED. The authors reviewed 18 clinical studies that evaluated the efficacy of a COX-2 inhibitor for the treatment of acute dental pain. All of the studies used the widely established third-molar surgical extraction model to induce postsurgical inflammatory based pain, and all were randomized, double-blinded and placebo-controlled. However, numerous vagaries in overall study design made direct comparisons difficult. RESULTS: None of the studies established any of the COX-2 inhibitors as clearly better than ibuprofen, the current gold standard for the treatment of surgically induced dental pain. However, in single-dosing scenarios, the COX-2 inhibitor often demonstrated a longer duration of action compared with ibuprofen. CLINCAL IMPLICATIONS: The evidence to date fails to demonstrate any therapeutic advantage to using a COX-2 inhibitor to treat acute dental pain compared with ibuprofen. In the rare event that a COX-2 inhibitor may be appropriate, the clinician must inform the patient of the potential risks, and the drug should be used for the shortest possible time.

Analgesics↗
PubMed1997

Pain control in recovering alcoholics: effects of local anesthesia.

OBJECTIVE: The medical literature suggests that alcoholics may present greater challenges to achieving clinical pain control than nonalcoholics. This study was undertaken to test the hypotheses that: (1) significant differences exist between alcoholics and nonalcoholics on detection and pain thresholds during electric tooth stimulation; (2) group differences exist in the depth and time course of pulpal anesthesia; and (3) responses to tooth stimulation are associated with severity of alcoholism and/or other psychological factors. METHOD: Male alcoholics (n = 22) in aftercare treatment (mean length of sobriety = 113 days) and age-matched nonalcoholics (n = 22) received 1.0 ml of 3% mepivicaine at the apex of a maxillary lateral incisor and saline placebo at the apex of the contralateral incisor. RESULTS: At baseline no group differences were found on sensory thresholds. During drug intervention significant drug and time effects for both detection threshold (p < .0001) and pain threshold (p < .0001) were found, but group differences and interactive effects were not significant. By exploratory regression analysis of alcoholic subjects, history of depression/unhappiness was significantly associated with shallower pulpal anesthesia, whereas high need for control/low actual control and frequency of treatment for detoxification were associated with deeper anesthesia. CONCLUSIONS: Our findings suggest alcoholics in recovery are not at increased risk for inadequate pain control with local anesthesia.

Adult↗
PubMed2004

[Dental pain as the reason for visiting a dentist in a Brazilian adult population].

OBJECTIVE: The occurrence of orofacial pain and chronic pain are frequent subjects for study today, but few studies have been made on dental pain in Brazil. The objective of the study was to assess the prevalence of dental pain and the associated factors as the reason for visiting a dentist among adults. METHODS: A cross-sectional study was carried out among 860 workers aged 18-58 years at a cooperative located in the State of Santa Catarina, in 1999. The clinical examinations and interviews were carried out by dentists who had received prior guidance. Complaints of dental pain as the reason for the last visit to a dentist were analyzed as the dependent variable, in relation to the socioeconomic and demographic conditions, access to dental services, shift pattern and caries (via the DMFT index), as the independent variables. Non-conditional multiple logistic regression analysis was utilized. RESULTS: The prevalence of dental pain as the reason for the last visit to a dentist was 18.7% (CI 95%: 15.9-20.1) and the mean DMFT index (decayed, missing and filled teeth) was 20.2 (CI 95%: 19.7-20.7), with 54% represented by the 'missing' component. The following were independently associated with the presence of dental pain: schooling of less than or equal to eight years (OR=1.9; CI 95%: 1.1-3.1); four to fifteen teeth lost due to caries (OR=2.6; CI 95%: 1.4-4.9); 16 to 32 teeth lost due to caries (OR=2.5; CI 95%: 1.1-5.8); and not having visited the company's dental service (OR=2.8; CI 95%: 1.6-5.1). CONCLUSIONS: Dental pain reflects the severity of the dental caries, expressed by the 'missing' component of the DMFT and non-usage of the company's dental services. These factors are determined by social conditions and represented by the schooling level.

Adolescent↗
PubMed2005

Dental pain, socioeconomic status, and dental caries in young male adults from southern Brazil.

The aim of this study was to assess dental pain prevalence and its association with dental caries and socioeconomic status in 18-year-old males from Florianópolis, Santa Catarina, Brazil. A cross-sectional study was conducted in a random sample (n = 414) selected from the Brazilian Army conscription list in 2003. Dental pain during the 12 months prior to the interview was recorded as the outcome. Socioeconomic data were obtained through a questionnaire. Dental caries experience was registered according to the DMFT Index. Analyses included simple and multiple non-conditional logistic regression following a hierarchical approach. Response rate was 95.6%. High rates of inter-examiner agreement were achieved (kappa > 0.83). Dental pain prevalence was 21.2% (95%CI: 17.3-25.1). After adjustment, individuals with one or more untreated caries were 3.2 times more likely (95%CI: 1.7-5.8) to have dental pain compared to caries-free subjects. Conscripts with low family income were 1.8 times more likely (95%CI: 1.0-3.3) to have dental pain than those with higher income.

Adolescent↗
PubMed2004

Dental pain prevalence and association with dental caries and socioeconomic status in schoolchildren, Southern Brazil, 2002.

The objective of this study was to assess the relation between dental pain, dental caries and socioeconomic status among 12- and 13-year-old schoolchildren enrolled in a public school in Florianópolis, SC, Brazil in 2002. This study was a cross-sectional study involving 181 schoolchildren. Dental pain experience was the dependend variable analyzed. Socioeconomic data of the children's families were obtained through a questionnaire. Dental caries experience was registered according to the DMFT index (WHO, 1997). The field workteam consisted of an examiner and a recorder. The statistical analysis was performed using the chi-square test and the non-conditional multiple logistic regression. The response rate was 93.4%. The intraexaminer agreement measured on a tooth by tooth basis was high (kappa > 0.73). Dental pain prevalence was 33.7% (CI95% 26.0-42.0). The multiple regression analysis, adjusted by sex and other variables, showed that children with DMFT > 1 presented 2.9 (OR CI95% 1.4-6.1, p < 0.01) more chances of having dental pain when compared with those with DMFT < or = 1. Children whose mother's schooling level was equal or less than 4 years presented 2.5 (OR CI95% 1.2-5.6, p = 0.02) more chances of having dental pain when compared with others whose mothers had more than 5 years of schooling and, finally, children whose family income was up to U$ 67.00 showed 3.2 (OR CI95% 1.2-8.4, p = 0.02) more chances of having dental pain when compared with the ones whose families had higher income. High levels of caries attack, low mother schooling level and low family income were associated to dental pain.

Adolescent↗
PubMed2005

Long term radiographic study of bilateral second premolars with immature root treated by apexogenesis and apexification.

A ten-year-old girl broke the central cusps of the mandibular second premolars. The mandibular right second premolar was treated with apexification and the left with apexogenesis. These methods were chosen in view of the presented clinical symptoms, radiographic findings, and outcome of bacterial cultures of root canal samples. At postoperative 2 years 8 months, disappearance of the focus, closure of the root canal, and formation of the root apex were observed in both mandibular premolars. The mandibular left second premolar demonstrated a nearly normal root formation and root apex morphology. Immediately beneath the extracted pulp, regular, uniform, and thick hard tissue was formed. Meanwhile, in the mandibular right second premolar, root growth was suspended, making the root short, and the contour was constructed in such a way that it encircled the distal apical area from the mesial side forming the root apex.

Bicuspid↗