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DATA SOURCES: Cochrane Oral Health Group Trials Register and the Pain, Palliative Care and Supportive Care Group Trials Register, the Cochrane Central Register of Controlled Trials, Medline and Embase. STUDY SELECTION: Randomised controlled trials (RCT) were included that involved patients over the age of 18 years who had presented with a single tooth with a clinical diagnosis of irreversible pulpitis. DATA EXTRACTION AND SYNTHESIS: Abstracts of studies were independently assessed by two reviewers. The primary outcome was patient-reported pain (intensity/duration) and pain relief measured on a categorical scale in the preoperative phase of irreversible pulpitis. Secondary outcomes were type, dose and frequency of medication required for pain relief. Only one trial was included so pooling of data from studies was not possible and a descriptive summary is presented. RESULTS: One trial of 40 participants was included. There was a close parallel distribution of the pain ratings in both the intervention and placebo groups over the 7-day study period. The between-group differences in sum pain intensity differences for the penicillin group were 6.0+/-10.5, and for placebo 6.0+/-9.5 (P=0.776; differences assessed by Mann-Whitney-Wilcoxon test considered to be statistically significant at P=0.05). The sum pain percussion intensity differences for the penicillin group were 3.5+/-7.5 and placebo 2.0+/-7.0 (P=0.290). There was no significant difference in the mean total number of ibuprofen tablets (P=0.839) and acetaminophen tablets (P=0.325) taken for pain relief in either group over the study period. The administration of penicillin over placebo did not appear to significantly reduce the quantity of analgesic medication taken (P=0.05) for irreversible pulpitis. CONCLUSIONS: This review based on one methodologically sound but low-powered small sample trial, provides some evidence that there is no significant difference in pain relief between individuals who had untreated irreversible pulpitis who did or did not take antibiotics in addition to analgesics.
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BACKGROUND: Pulpitis, a prevalent inflammatory dental disease, primarily results from bacterial infection, yet its epigenetic regulatory mechanisms remain poorly understood. PIWI-interacting RNAs (piRNAs), a class of small non-coding RNAs known to maintain genomic stability, have not been investigated in the context of pulpitis. OBJECTIVE: This study aimed to profile piRNA expression patterns in pulpitis and to elucidate the functional role and underlying mechanism of a specific piRNA, piR-36241 and its target gene ADGRG2 in disease progression. METHODS: piRNA and mRNA sequencing were performed on pulp tissues from patients with irreversible pulpitis and healthy controls. Potential piRNA targets were predicted bioinformatically. The interaction between piR-36241 and the 3'UTR of ADGRG2, an orphan adhesion G protein-coupled receptor (GPCR), was validated using dual-luciferase reporter assay, quantitative Real-Time PCR (qRT-PCR), fluorescence in situ hybridization (FISH), Western blot (WB), hematoxylin-eosin staining (HE), immunohistochemistry (IHC) and enzyme-linked immunosorbent assay (ELISA). Functional analyses were conducted in LPS-stimulated human dental pulp cells (HDPCs) through gain-of-function and rescue experiments. RESULTS: We identified a distinct piRNA expression profile in pulpitis, with 21 piRNAs differentially expressed. piR-36241 was notably upregulated. It directly targeted the 3'UTR of ADGRG2 and suppressed its expression. ADGRG2, hypothesised to exert protective and homeostatic functions, was downregulated in pulpitis tissues and LPS-induced HDPCs. Overexpression of piR-36241 inhibited ADGRG2 expression and promoted the secretion of pro-inflammatory cytokines (IL-6, IL-8). Conversely, knockdown of ADGRG2 similarly enhanced inflammatory responses. Rescue experiments demonstrated that piR-36241 primarily regulates inflammation through ADGRG2 silencing. CONCLUSION: Our study reveals a novel pathogenic axis in pulpitis whereby upregulation of piR-36241 exacerbates inflammatory progression by repressing the protective receptor ADGRG2. These findings provide the first evidence of piRNA-mediated epigenetic regulation in pulpitis and highlight the piR-36241/ADGRG2 pathway as a potential therapeutic target for preserving pulp vitality.
BACKGROUND: Irreversible pulpitis, which is characterised by acute and intense pain, is one of the most frequent reasons that patients attend for emergency dental care. Apart from removal of the tooth the customary way of relieving the pain of irreversible pulpitis is by drilling into the tooth, removing the inflamed pulp (nerve) and cleaning the root canal. However, a significant minority of dentists continue to prescribe antibiotics to stop the pain of irreversible pulpitis. OBJECTIVES: The objective of this review was to provide reliable evidence regarding the effectiveness of prescribing systemic antibiotics for irreversible pulpitis by comparing clinical outcomes expressed as pain relief. SEARCH STRATEGY: We searched the following databases: Cochrane Oral Health Group Trials Register and Pain, Palliative Care and Supportive (PaPaS) Care Group Trials Register to 6th September 2004; the Cochrane Central Register of Controlled Trials (CENTRAL) The Cochrane Library Issue 3 2004; MEDLINE (1966 to 6th September 2004); EMBASE (1980 to week 36 2004). SELECTION CRITERIA: This review includes one randomised controlled trial which compared pain relief with systemic antibiotics and analgesics, against placebo and analgesics in the acute preoperative phase of irreversible pulpitis. DATA COLLECTION AND ANALYSIS: Only one trial is included in this review, therefore pooling of data from studies was not possible and a descriptive summary is presented. MAIN RESULTS: One trial involving 40 participants was included in this review. There was a close parallel distribution of the pain ratings in both the intervention and placebo groups over the 7 day study period. The between-group differences in sum pain intensity differences (SPID) for the penicillin group were (6.0+/-10.5), and for placebo (6.0+/-9.5) P = 0.776. The sum pain percussion intensity differences (SPPID) for the penicillin group were (3.5+/-7.5) and placebo (2.0+/-7.0) P = 0.290, with differences as assessed by the Mann-Whitney-Wilcoxon test considered to be statistically significant at P < 0.05. There was no significant difference in the mean total number of ibuprofen tablets (P = 0.839) and Tylenol tablets (P = 0.325), in either group over the study period. The administration of penicillin over placebo did not appear to significantly reduce the quantity of analgesic medication taken (P > 0.05) for irreversible pulpitis. AUTHORS' CONCLUSIONS: This review which was based on one methodologically sound but low powered small sample trial provided some evidence that there is no significant difference in pain relief for patients with untreated irreversible pulpitis who did or did not receive antibiotics in addition to analgesics.
Ten male, albino rabbits, weighing about 2,5 kg, were sensitized with 0.05% of 1-chloro-2,4-dinitrobenzene (DNCB) in complete Freund's adjuvant. Ten controls received the complete Freund's adjuvant only. Fourteen days later, the animals were submitted to a dental test. The four incisor pulps were exposed under general anesthesia. A sterile cotton pellet with 10-(-4) mg of DNCB was sealed inside the cavity. A skin test was also performed with 0.1% DNCB. The operative trauma was evaluated on five additional control animals. Twenty four hours after the challenge, the animals were killed and their teeth were studied histologically. Three different pulpitis were observed: 1) in animals without DNCB, a traumatic pulpitis with a mild focal necrosis and serous infiltrate; 2) a toxic pulpitis induced by the DNCB in the controls. They were killed and their teeth were studied histologically. Three different kinds of pulpitis induced in sensitized animals. A considerable necrosis is present close to the pulp exposure. This pulpitis is characterized by a marked serous exudate and by an accumulation of lymphocytes, eosinophils and macrophages, either perivascularly or in the pulpal mesenchyme. A modification of the present classification of pulpitis is proposed.
OBJECTIVE: This retrospective study compared differences in preoperative pain and medication use in patients with moderate to severe pain who sought emergency endodontic care for teeth with irreversible pulpitis and for symptomatic teeth with necrotic pulps. STUDY DESIGN: A total of 323 patients seeking emergency endodontic treatment completed questionnaires regarding their biographical information, pain, pain history, and medications. Teeth were tested for vitality, mobility, percussion, and palpation pain. Lymphadenopathy was also evaluated. RESULTS: Patients with irreversible pulpitis waited significantly (P <.05) longer before seeking emergency care (9 days vs 4 days) than patients with symptomatic teeth with necrotic pulps. No differences (P >.05) were found between the groups in terms of analgesic or antibiotic use and pain relief from preoperative narcotic medications. Nonnarcotic analgesics were reported to significantly reduce pain more often in patients with symptomatic teeth with necrotic pulps. There were sex differences in the group of patients with irreversible pulpitis: More women than men were taking analgesic medications and, in the group having symptomatic teeth with necrotic pulps, more men than women reported pain relief from their analgesic medications. CONCLUSION: Patients with irreversible pulpitis wait longer to seek emergency treatment. A majority (81%-83%) of emergency patients with moderate to severe pain will have taken some type of medication(s) to help control their pain, and more women than men with irreversible pulpitis will take an analgesic. By taking their preoperative medication(s), this group of patients will get relief 62% to 65% of the time; furthermore, more men than women with symptomatic teeth with necrotic pulps will experience pain relief.
AIM: The purpose of this histological study was to examine teeth with hyperplastic pulpitis caused by trauma or caries. SUMMARY: The pulp tissue of one young permanent incisor with a complicated crown-root fracture and a hyperplastic pulpitis, which had been contaminated with oral microflora for 40 days, and pulp polyps from four permanent first molars whose crowns were destroyed by extensive caries were prepared for standard histological examination. Histologically, normal pulp tissue organization was observed in the tooth with a complicated crown-root fracture in the cervical radicular region. Irregular calcification was seen in the coronal and radicular portion of the pulp in the four carious teeth with pulp polyps. Radicular pulp tissue in the middle and apical third of root canals beneath irregular calcification showed intensive fibrosis but was free from inflammatory cells. KEY LEARNING POINTS: Hyperplastic pulpitis is a type of irreversible chronic open pulpitis. Young permanent teeth with hyperplastic pulpitis caused by trauma or caries have a great inherent defensive capacity to heal.
OBJECTIVE: The purpose of this prospective, randomized, double-blind study was to determine the effect of penicillin on pain in untreated teeth diagnosed with irreversible pulpitis. STUDY DESIGN: Forty emergency patients participated, and each had a clinical diagnosis of an irreversible pulpitis. Patients randomly received a 7-day oral dose (28 capsules, 500 mg each, to be taken every 6 hours) of either penicillin or a placebo control in a double-blind manner. No endodontic treatment was performed. Each patient also received ibuprofen; acetaminophen with codeine (30 mg); and a 7-day diary to record pain, percussion pain, and number and type of pain medication taken. RESULTS: The administration of penicillin did not significantly (P >.05) reduce pain, percussion pain, or the number of analgesic medications taken by patients with untreated irreversible pulpitis. The majority of patients with untreated irreversible pulpitis had significant pain and required analgesics to manage this pain. CONCLUSION: Penicillin should not be prescribed for untreated irreversible pulpitis because penicillin is ineffective for pain relief.
BACKGROUND: In the case of pulpitis the dentist has to differentiate between a reversible and therefore treatable pulpal inflammation and an irreversible damage of the pulpa, accord-ing to the clinical symptoms. From these one cannot draw conclusions about the effective histological condition of the pulpa. Early stages of pulpitis cannot be recognized by X-rayeither. OBJECTIVES: By means of case studies in the course of daily dental practice the following questions are addressed:Is dental pulpitis an indication for the use of the Tibetan remedy Padma 28? Can a root canal treatment be prevented by administering Padma 28? What dosage is appropriate in this indication? PATIENTS AND METHODS: 53 patients with symptoms of chronic dental pulpitis but without clear indication for an im-mediate root canal treatment were prescribed 2 x 2 tablets Padma 28 daily, for 15 days. 49 patients took the preparation,and the course of symptoms was recorded and analyzed according to a simple scheme. RESULTS: 27 of these patients(55%) were free of pain within 1 month. A total of 40 patients(81%) reached a pain-free state after a longer period. By now, in most cases observations have been made for a period of 2-3 years (maximum: 5.5 years). 12 patients (24%) remained without relapse so far for more than 3 years. These experiences allow to deduce possible indications and clinical symptoms for the use of Padma 28. CONCLUSIONS: These results en-courage the use of Padma 28 as a complementary preparation with little side effects, in unclear cases of pulpitis. The clinical development can be observed without further treatment if the patient does not need pain medication. Most patients (>80%) showed a complete remission, positively affect-ed and expedited by Padma 28; root canal treatments or ex-tractions could be prevented. In many cases the improvement has sustained over observation periods of >3 years. Criteria for therapeutic decisions are proposed.
PURPOSE: To explore the application and the anaesthetic effect of primacaine in anaesthetizing the pulp. METHODS: 162 teeth of pulpitis underwent submucous infiltration anaesthesia via the labial or buccal side (single side anaesthesia). There were 94 teeth of acute pulpitis and 68 teeth of chronic pulpitis among them. Anaesthesia effect were observed.Maxillary, mandibular molars and mandibular premolar were respectively divided into two groups, one underwent submucous infiltration anaesthesia via the labial or buccal and lingual sides (double sides anaesthesia), the other underwent single side anaesthesia. The data was analysed with X(2) test. RESULTS: The effective rate of single side anaesthesia was 72.8%, There was no significant difference between acute and chronic pulpitis(P>0.05). For mandibular molar,the effect of double side anaesthesia was better than the single side anaesthesia (P<0.05). CONCLUSIONS: Primacaine had a good anaesthesia effect when the teeth of pulpitis underwent pulpectomy. In order to get perfect anaesthetic effect, the double side anaesthesia for the mandibular molar was suggested.
Odontogenic pain often involves inflammation of dental pulp tissue. Dental pulp is highly innervated with a subpopulation of sensory neurons containing neuropeptides. Substance P, released from afferent fibers (e.g. nociceptors) is associated with the development of neurogenic inflammation. In this study, we tested the hypothesis that irreversible pulpitis is associated with increased activity of peptidergic neurons, as measured by increased pulpal levels of immunoreactive substance P (iSP). We determined in vivo pulpal levels of immunoreactive substance P in human teeth with a diagnosis of normal pulp or irreversible pulpitis using CMA/20 microdialysis probes inserted into vital pulps of 24 teeth from 21 patients. Probes were perfused with a modified Locke-Ringer's buffer and immunoreactive substance P levels in the dialysate were measured using a radioimmunoassay. Mean extracellular levels of immunoreactive substance P were significantly higher (>8-fold) in teeth diagnosed with irreversible pulpitis than immunoreactive substance P levels in dental pulp diagnosed as normal (147.7 +/- 34.0 pM versus 18.2 +/- 6.2 pM). These observations suggest that biochemical measures of inflammatory mediators exhibit significant change during irreversible pulpitis and may contribute to clinical signs and symptoms.
AIM: To evaluate the Transforming Growth Factor-beta 1 (TGF-beta 1) expression in normal healthy pulps and in those with irreversible pulpitis. METHODOLOGY: Twenty-three normal, healthy pulps were removed from mandibular third molars, and 20 pulps were retrieved from teeth with irreversible pulpitis. TGF-beta 1 was evaluated in the odontoblastic and subodontoblastic layers, in the stromal cells (fibroblasts), and in the blood vessels. TGF-beta 1 expression was determined by evaluating 500 cells in the odontoblastic and subodontoblastic layers and 500 fibroblasts in the stroma for each specimen, and counting the number of positive cells. The number of the positive vessels was evaluated in 10 high power fields (HPF). In almost all cases, the cellular positivity was cytoplasmatic. Statistical analysis was performed using Mann-Whitney U- and Student's t-tests. RESULTS: A higher expression of TGF-beta 1 was found in the odontoblastic-subodontoblastic layer of the irreversible pulpitis specimens; this difference was statistically significant (P = 0.0002). No statistically significant difference was observed between the two groups in TGF-beta 1 expression in the stromal cells (P = 0.54) or in the vascular component (P = 0.94). CONCLUSIONS: The higher and statistically significant expression of TGF-beta 1 found in the odontoblastic-subodontoblastic layer of irreversible pulpitis specimens may indicate a role for TGF-beta 1 in the dentinal repair processes after pulp inflammation.
Hyperplastic pulpitis is a variety of chronic open pulpitis which is regarded as irreversible. This condition is usually treated by root canal treatment, unless coronal damage does not permit restoration, in which case extraction is indicated. In the present study, 24 permanent teeth of individuals, aged 10-22 years and diagnosed as hyperplastic pulpitis were treated by pulpotomy using an atraumatic surgical technique with calcium hydroxide alone. The treatment was successful in 22 teeth, according to the following criteria: absence of clinical symptoms, absence of any intraradicular or periradicular radiographic pathological changes, presence of dentine bridge detected by clinical examination and sometimes observed radiographically, and sensitivity to electrical stimulation. The follow-up examination ranged from 12 to 48 months. The high frequency of clinical healing in this study appears to justify recommending pulpotomy as the treatment regime in selected cases of chronic hyperplastic pulpitis.
Dental caries is the result of microbial activities that induce the progressive localised destruction of teeth. Without treatment, this eventually results in infection of the dental pulp and surrounding periapical tissues. Although the bacteria responsible for caries initiation and early caries progression have been extensively studied, the microbiology of dentine caries reportedly shows considerable diversity and the associated microflora has not yet been fully identified. A search of the literature shows that few studies have analysed the microbiology of deep caries or examined the relationship between this microflora and the histopathology of chronic pulpitis in symptomatic teeth. The majority of the studies investigating the microbiology of carious dentine have used traditional culture methodology that has been reported to be fraught with difficulties and to underestimate the microbial populations. However, recent work using new technology in the form of Polymerase Chain Reaction (PCR) has shown potential by enhancing the identification and quantification of bacteria from complex environments. Application of this technology to carious dentine has identified an environment dominated by anaerobic organisms and containing significant numbers of Gram-negative bacteria that have been strongly implicated in endodontic infections subsequent to carious pulpitis. Examination of the histopathology of pulp sections from teeth extracted as a result of carious pulpitis showed pulpal reactions ranging from minimal inflammation to marked inflammatory infiltration of the pulp tissue. Of interest, were hard and soft tissue pathologic changes noted in the pulp tissues resulting from the combined effects of the carious microorganisms and the host tissue response. Improved knowledge of the microbial species associated with pulpitis could create the potential for development of diagnostic tools and restorative materials with appropriate antimicrobial properties.
The objective of this equivalency study was to see if a colony of Streptococcus mutans placed into cavities in primary molar teeth produced pulpitis similar to an established pulpitis induction method using carious dentine. In two juvenile baboons (Papio ursinus), occlusal cavities were cut in all 16 primary molar teeth, followed by making a small pulpal exposure after which the cavity was swabbed with 37 per cent phosphoric acid. In one half of the teeth, fresh soft human carious dentine was placed over the pulpal exposure; in the remaining teeth the exposure was covered with a colony of Streptococcus mutans in agar. All the cavities were restored with unlined light-cured composite resin. After 14 days specimens were harvested and examined under the light microscope with the examiner blind to the induction method. In both groups of teeth there was recognisable pulp, hyperaemia, micro-abscesses in the pulp and peri-apical abscesses. Reactions to soft caries were more severe than to Streptococcus mutans. The results show that Streptococcus mutans placed in a cavity with an exposure produces comparable pulpitis to fresh soft human carious dentine in the same type of cavity and that both methods produce pulpitis suitable for testing pulpotomy or pulpectomy treatments.