Management of endodontic emergencies.
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Pulp tissue may suffer from carious invasion, direct or indirect trauma and last but not least from dental treatment. As the general population grows older and retains longer its dentition, teeth will inevitably experience a complex history of multiple episodes of aggressions. It is therefore not surprising that the dental practitioner is confronted more and more with teeth reacting acutely or chronically (in other words, painfully or not) after proper dental treatment. This paper describes the common pathologic and iatrogenic events that may have an effect on the pulpal health status. Preventive endodontic treatment is to be considered in cases of extensive dental treatment.
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Malocclusion, as an etiological agent in dental disease, is among the most controversial subjects in dentistry. Bruxism has been blamed on stress and many other nondental factors. A biomechanical mechanism that serves as a contributing factor to stimulate tooth clenching and grinding is defined and used to identify the 12 common dental symptoms caused by tooth clenching and grinding. A method is proposed through which the practitioner can link the observable dental signs with the biomechanical factors for accurate diagnosis and appropriate treatment, preferably at an early stage before the damage becomes severe.
OBJECTIVE: The purpose of this study was to evaluate the degree of color change, any rebound effect, and sensitivities associated with using 2 different concentrations of carbamide peroxide in vivo. METHOD AND MATERIALS: Twenty-five subjects used 10% and 15% agents in trays for 14 days on different sides of their maxillary arches. Subjects returned in 3 days and at 1, 2, 3, and 6 weeks for evaluation of color change and rebound effect. Shade matching, photographic means, and a colorimeter were used for evaluation. Subjects self-reported gingival and tooth sensitivity on a scale of 1 (no sensitivity) to 5 (severe sensitivity). RESULTS: After 2 weeks, delta L*, delta a*, delta b*, delta E* and delta shade guide rank means for the 10% whitening agent were 6.50, -1.37, -4.63, 8.79, and -15.40, respectively; for the 15% agent, they were 8.72, -1.63, -5.90, 11.03, and -16.59, respectively. After 6 weeks, delta L*, delta a*, delta b*, delta E*, and delta shade guide rank means for the 10% whitening agent were 3.04, -0.99, -3.19, 5.13, and -13.13, respectively; for the 15% agent, they were 3.48, -1.01, -3.60, 5.58, and -13.65, respectively. Means for gingival sensitivity were 1.18 and 1.21 for the 10% and 15% agents, respectively; means for tooth sensitivity were 1.21 and 1.26 for the 10% and 15% agents, respectively. CONCLUSION: All 3 methods of evaluation revealed a significant difference in the tooth lightness achieved by 10% and 15% products at 2 weeks but no significant difference at 6 weeks. No statistically significant difference was found in gingival or tooth sensitivity.
PURPOSE: This study was performed to describe and relate sociodemographic factors and management of visits to a pediatric hospital emergency department for caries-related dental pain. METHODS: Retrospective chart review of cases with a verifiable chief complaint of caries-related dental pain in 1998, was conducted using established protocol and trained reviewers. RESULTS: Three hundred of 984 hospital ED dental emergencies met the study's selection criteria and 109 children were six years old or younger. Almost two-thirds (66%) came from single parent families. Fifty-eight percent were self-pay or covered by government programs and the rest had some insurance. African-American children were 45% of cases. Over 80% were from within Franklin County, OH. Only 4 children (1%) had been seen for the same tooth previously. Lower primary molars were most often affected. Race, insurance, parental marital status were not significantly related to follow-up attendance at the facility (P > 0.05). Those living outside Franklin County and under 5 years of age were more likely to attend follow-up appointments (P < 0.05). When compared to the catchment population of Franklin County, this ED sample had six times as many uninsured children, two and a half times more African-Americans, and came from single parent families four and a half times more often. CONCLUSIONS: Children seen in the ED were predominantly poor, from single-parent families, and disproportionately minority, and were different from the catchment area population. These social risk factors were not related to attendance at follow-up.
Atypical facial pain, stomatodynia, atypical odontalgia, masticatory muscle and some temporomandibular joint disorders are grouped together under the category of orofacial idiopathic pain as they reveal numerous common clinical features. For each of these entities, problems of definition and terminology are discussed. Epidemiological and demographic data and a semiological description are given. Proposed diagnostic criteria and some of the causes or mechanisms common to these entities are also described in this article. Firstly, the rôle of female hormones in the physiology and treatment of certain patients is suggested with regard to the marked prevalence of changes in oestrogen levels in patients with orofacial idiopathic pain. Postmenopausal osteoporosis and the hypothesis of neuralgia due to the presence of cavities of osteonecrosis are placed within the context of atypical facial pain. A neuropathic component is suggested for these pain entities. These latter may be linked to a phenomenon of central sensitisation that is induced and maintained by activity in the peripheral tissues. Clinical features of both atypical facial pain and atypical odontalgia have led several authors to advocate the existence of a sympathetic mechanism in the physiopathology of these entities. Moreover, some arguments emphasize similarities with Complex Regional Pain Syndromes of limbs. Lastly, psychosocial components are also considered as a common factor, but it is currently impossible to determine if the pain is the cause or the result of psychosocial problems. Currently, none of these mechanisms can be considered as a single established etiological factor. Indeed, each of these mechanisms can be observed in all types of orofacial idiopathic pain. This leads to the hypothesis that these different mechanisms may act on each target tissue but the details of interaction are still unknown.
Patients have the right to expect effective pain control and relief following dental treatment. In recent years, clinical guidelines on pain control have been published and disseminated. This article reviews current concepts of pain and principles of effective pharmacologic pain control. This material was presented as part of the 57th Tennessee Dental Association Postgraduate Dental Seminar.
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Partial toothlessness, lately or wrongfully compensated, are at the origin of prosthetics problems often difficult to solve. We shall explain the importance of dental grooves in the prosthetics process, through different cases of temporomandibular dysfunction.
We are faced every day with the problem of dental pain arising from the concomitant action of the nerve fibres, the odontoblasts and the dentinal fluid. Its propagation is due to the triggering of the action potential from the resting potential. It can be reduced thanks to a reversible process of anelectrotonus in electro-analgesia.
This study was conducted to determine the incidence of pain during and after root canal treatment. Complete debridement and root canal preparation was performed in first visit. The frequency of pain was recorded and evaluated in 150 patients receiving root canal treatment. Results has shown that incidence of pain was 6.66% root canal preparation in vital teeth and 21% in non-vital teeth (necrosis). Post-obturation pain occurred in 18.75% for vital teeth and 13.15% non-vital teeth (necrosis).
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