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PubMed2006

Diagnostic imaging for chronic orofacial pain, maxillofacial osseous and soft tissue pathology and temporomandibular disorders.

Since dentists can be faced by unusual cases during their professional life, this article reviews the common orofacial disorders that are of concern to a dentist trying to diagnose the source of pain or dysfunction symptoms, providing an overview of the essential knowledge and usage of nowadays available advanced diagnostic imaging modalities. In addition to symptom-driven diagnostic dilemmas, where such imaging is utilized, occasionally there are asymptomatic anomalies discovered by routine clinical care and/or on dental or panoramic images that need more discussion. The correct selection criteria of an image exam should be based on the individual characteristics of the patient, and the type of imaging technique should be selected depending on the specific clinical problem, the kind of tissue to be visualized, the information obtained from the imaging modality, radiation exposure, and the cost of the examination. The usage of more specialized imaging modalities such as magnetic resonance imaging, computed tomography, ultrasound, as well as single photon computed tomography, positron electron tomography, and their hybrid machines, SPECT/ CT and PET/CT, are discussed.

Bone Diseases↗
PubMedDate not supplied

Comparison of mineral trioxide aggregate and calcium hydroxide as pulpotomy agents in young permanent teeth (apexogenesis).

PURPOSE: The purpose of this study was to compare mineral trioxide aggregate (MTA) with calcium hydroxide (Ca(OH)2) clinically and radiographically as a pulpotomy agent in immature permanent teeth (apexogenesis). METHODS: Fifteen children, each with at least 2 immature permanent teeth requiring pulpotomy (apexogenesis), were selected for this study. All selected teeth were evenly divided into 2 test groups. In group 1, the conventional Ca(OH)2pulpotomy (control) was performed, whereas in group 2, the MTA pulpotomy (experimental) was done. The children were recalled for clinical and radiographic evaluations after 3, 6, and 12 months. RESULTS: The follow-up evaluations revealed failure due to pain and swelling detected at 6 and 12 months postoperative evaluations in only 2 teeth treated with Ca(OH)2. The remaining 28 teeth appeared to be clinically and radiographically successful 12 months postoperatively. Calcific metamorphosis was a radiographic finding in 2 teeth treated with Ca(OH)2 and 4 teeth treated with MTA. CONCLUSIONS: Mineral trioxide aggregate showed clinical and radiographic success as a pulpotomy agent in immature permanent teeth (apexogenesis) and seems to be a suitable alternative to calcium hydroxide.

Aluminum Compounds↗
PubMedDate not supplied

Experience and policy implications of children presenting with dental emergencies to US pediatric dentistry training programs.

PURPOSE: The purpose of this study was to describe and substantiate the experience of children, their families, and their caregivers with children's dental pain and to explore implications of these experiences for public policy. METHODS: Data for 301 children presenting to 35 pediatric dentistry training programs during a 1-week period in 2000 for pain relief were collected with a questionnaire asking for: (1) sociodemographic characteristics; (2) oral health status; (3) dental care history; (4) presenting problem; (5) clinical findings; and (6) clinical disposition. Descriptive statistics are presented. RESULTS: Among children presenting to training programs with oral pain, 28% were under age 6, 57% were on Medicaid, and 38% were regarded by their dentists to have "likely or obvious" functional impairment-with 22% reporting the highest pain level. Parents reported that 59% had "poor or fair oral health" and 29% had a prior dental emergency in the previous year. Pain, experienced for several days by 73% of children, was associated with difficulty: (1) eating; (2) sleeping; (3) attending school; and (4) playing. Parent-reported barriers to seeking dental care included: (1) missed work (24%); (2) transportation costs (12%); and (3) arranging child care (10%). CONCLUSION: In this study of children with dental pain, many suffered significant pain: (1) duration; (2) intensity; (3) recurrence; and (4) consequences. This study demonstrates the ongoing need for public policies that assure timely, comprehensive, and affordable dental care for vulnerable children.

Absenteeism↗
PubMed2006

Basic oral health needs: A public priority.

Is there a way to support a special ethical status for unmet oral health needs within our pluralistic, liberty-loving American society? Some people in American society, perhaps many people, believe that some kinds of human needs have special ethical importance. But very few people outside the oral health professions have ever considered that unmet oral health needs might belong to this category. This article will examine why some kinds of needs are thought to have special ethical importance and propose that certain categories of oral health care are needs that fit this description. Without thinking these issues through, we who argue for improved access to oral health care will remain unable to provide an adequate answer to a very legitimate question, namely: improved access to what? When this task has been completed, the article will consider some of the implications of such a view for our society.

Dental Care↗
PubMed2006

The use of general anaesthesia for the extraction of children's teeth. Results from two UK dental hospitals.

AIM: To study the reasons forgiving children a general anaesthetic (GA) for the extraction of teeth, in two different paediatric dentistry centres and to compare them with draft guidelines disseminated for discussion by the British Society of Paediatric Dentistry (BSPD). METHODS: Data were collected on children who required GA extractions over a two month period (1st may to 30th June 2004) at the Paediatric Dental Units of Liverpool University Dental Hospital (LUDH) and the University Dental Hospital of Manchester (UDHM). The information collected included date of birth, gender, date of referral, date of assessment and date of GA. The reason for the GA was noted in terms of the proposed BSPD guidelines for short GA. RESULTS: A total of 264 and 268 children required extractions under GA at LUDH and UDHM respectively. At LUDH the main reason in 189 (72%) children was severe pulpitis requiring immediate relief of pain where a child does not have the intellectual maturity to cope with treatment under local analgesia (LA). This was followed by failed extractions under LA in 53 (20%) children. This reason is not listed under the proposed BSPD guidelines. At UDHM the main reason for GA in 114 (42%) children was symptomatic teeth causing pain in more than two quadrants (or in two quadrants necessitating the use of bilateral inferior dental blocks). CONCLUSIONS: There were differences in the clinical rationale for GA between children attending the two centres. Further information is needed to refine the proposed guidelines on the use of GA for dental extractions in paediatric dentistry. The guidelines need to be flexible and updated to reflect changes in practice and service provision.

Anesthesia, Dental↗
PubMed1990

[Mechanism of the modulation of pain transmission at the subnucleus caudalis of the trigeminal sensory nuclear complex in rabbits].

The modulation of dental pain transmission at the subnucleus caudalis of the trigeminal sensory nuclear complex (SpVc) was investigated in rabbits in vivo. The superficial layers of SpVc were perfused with artificial cerebrospinal fluid using a push-pull cannula system. Immunoreactive substance P (SP) released into the perfusates following electrical stimulation of the lower incisor pulp was measured. The obtained results were as follows. 1. An increase in the release of SP and [Met5]-enkephalin was observed by the electrical stimulation with 40 V. 2. The increase of SP release following electrical stimulation was inhibited by systemic administration of morphine (10 mg/kg i.v.) or local application of morphine (10(-6) M) to SpVc. The stimulus-evoked SP release was also inhibited by local application of [D-Ala2, Met5]-enkephalinamide (an analog of [Met5]-enkephalin; 10(-4) M). 3. Spontaneous release of serotonin (5-HT) into the perfusates was observed, while that of norepinephrine was not. Tooth pulp stimulation tended to increase the level of 5-HT. Systemic administration of morphine (10 mg/kg i.v.) and electrical stimulation of the nucleus raphe magnus (NRM) significantly enhanced the release of 5-HT. 4. The release of SP evoked by tooth pulp stimulation was inhibited by local application of 5-HT (10(-6)M) and electrical stimulation of NRM. These results suggest that there are two modulatory systems controlling the delivery of the ascending sensory message at the superficial layers of SpVc. One is an intrinsic mechanism associated with the segmental enkephalinergic system, the other is a descending monoaminergic system originating in NRM. It is also suggested that these two systems play an important role in producing the analgesic effect of morphine.

Afferent Pathways↗
PubMed1991

Management of endodontic emergencies.

Endodontic emergencies include situations of pain or swelling that require the immediate attention of a dentist. These emergencies interrupt the schedule of the patient and the dental team. This article reviews the clinical conditions that might require emergency therapy, etiologies of these conditions, and the minimal treatment needed to alleviate the signs and symptoms. Current opinions on these issues are presented.

Acute Disease↗
PubMed1991

Clinical experience in the treatment of dental pain.

Good dental analgesia requires drugs that are endowed with strong and fast activity and that are well tolerated. In addition, optimal analgesia should essentially be of the peripheral type, thereby eliminating the risk of sedation that may cause unpleasant effects on the patient's daily life. Meclofenamic acid is among those substances whose analgesic effect is more evident than that of anti-inflammatory action. The mechanism of action of meclofenamic acid makes it distinctly different from other nonsteroidal anti-inflammatory drugs (NSAIDs) in that it inhibits the metabolic pathways of arachidonic acid and, at the same time, antagonizes the effects of prostaglandins at the peripheral receptor level. A number of controlled clinical trials showed that meclofenamic acid is an excellent analgesic, offering good tolerability when used in oral surgery, dysodontiasis, avulsion of the third impacted molar, and periodontitis. The following report is a presentation of results obtained in a controlled clinical trial in which the speed of pain relief was assessed in 20 patients suffering from acute periodontitis. The patients were treated orally with a single dose of meclofenamate sodium (100 mg) or with piroxicam-beta-cyclodextrin (20 mg). The intensity of the drug's analgesic effect was measured at 0.5, 1, 2, 4, and 6 h after administration. After initial testing, meclofenamate sodium was found to be significantly more effective than piroxicam-beta-cyclodextrin. Both the physician and patient found this drug to be considerably better. Pain relief after treatment with meclofenamate sodium was clinically and statistically faster than piroxicam-beta-cyclodextrin, and both drugs were found to be well tolerated.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Multidisciplinary patient care in preventive dentistry: idiopathic dental pain reconsidered.

Pain is a complex phenomenon which challenges healthcare providers to develop multidisciplinary diagnostic and treatment competencies. This paper reviews literature on idiopathic odontalgia and tooth hypersensitivity without apparent cause, and considers the role bioelectric mechanisms may play in the onset and treatment of these moderately common disorders. The hypothesis considers that such pain may be associated with health disturbances in areas remote from the teeth and periodontium. A multidisciplinary approach to preventive dental health is discussed along with factors which may impact the outcome in the treatment of dental pain.

Acupuncture Analgesia↗
PubMed1991

[Psychogenic pain sensations in teeth, mouth and jaws].

Pain is always a subjective experience. Therefore the term "psychogenic pain sensation" seems to be a pleonasm at first sight. In fact, however, the dentist's attention should not only be focussed on the removal of the objective causes of pain, but the fact itself, i.e. the patient's subjectivity, must be considered, too. Unless this is done, the results are serious diagnostic and therapeutic errors.

Facial Pain↗
PubMed1991

[Piroxicam in analgesia].

Piroxicam, a NSAID with a proved analgesic and antiphlogistic efficacy, largely used in rheumatic-orthopedic pathologies, has an antalgic action also in extra-rheumatic pathologies, such as postoperative and dental pain and primary dysmenorrhea. This is probably due both to a peripheral mechanism, at the injured site level, which is particularly widespread, and goes from prostaglandin inhibition to suppression of the synthesis of different algesiogenic substances (oxygen free radicals, lytic enzymes), and to a direct non endorphin-mediated action at central level. The data base considered in this review, concerning piroxicam in extra-rheumatic analgesia, is of about 2,500 patients, in 26 clinical studies, mostly with an experimental double-blind placebo-controlled design or vs other NSAIDs. The doses ranged from 5 to 40 mg in a single administration: the doses of 20 and 40 mg showed an immediate analgesic effect, with the onset of analgesia within 30 min./1 hour from the administration. Analgesic activity was intense, comparable or superior to that of other drugs (aspirin, codeine, other NSAIDs) and more prolonged, often lasting as long as 24 hours. Tolerability of this data base was very satisfactory and comparable to that of the placebo, incidence of side effects being negligible.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMedDate not supplied

[A comparison of the effect of tranquilizers in experiments and clinical practice].

Experimental and clinical study of the analgesic effects of mebicar and benzodiazepine series tranquilizers (sibazon and chlozepid) and their combinations with non-narcotic analgesics (amidopyrin, pyranal) or local anesthetic lidocaine has demonstrated a more marked effect of benzodiazepine derivatives on pain sensitivity thresholds as against mebicar. Tranquilizer combinations with other analgesics helped define the optimal premedication variants: benzodiazepine derivative augment analgesic activity whereas mebicar potentiates lidocaine effect.

Adolescent↗