Toothaches that aren't really toothaches.
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OBJECTIVES: The aims of this study were twofold: (1) to describe patterns of change in reported toothache pain, and (2) to examine the impact of toothache pain on dental care utilization and vice versa. METHODS: Data from the Florida Dental Care Study (FDCS), a longitudinal study of oral health and dental service utilization conducted in north Florida, were used to measure self-reported toothache pain among dentate adults at baseline and four subsequent times during a 24-month period. Only persons 45 years of age or older with at least one remaining natural tooth at baseline were eligible. A total of 873 subjects participated, 764 of whom participated through 24 months. The analysis is focused on modeling transitions in the reported experience of toothache pain during intervals of six months. RESULTS: At the time of the baseline interview, 11.5 percent of subjects reported current toothache pain. During subsequent six-monthly interviews, from 13.4 percent to 21.6 percent of subjects reported having experienced toothache pain during the prior six-month interval. Among those with no toothache pain at baseline (n = 772), 31.2 percent experienced toothache pain at some time during the 24-month study period. The six-month incidence probability reflects the likelihood of developing toothache pain by estimating the conditional probability of reporting a toothache in a later interval given that this problem was not reported in the earlier one (for consecutive pairs of intervals). Overall, the six-month incidence probability for toothache pain in this study was. 11. Significantly higher 24-month incidence was observed for African-American subjects, those with less formal education, those in poorer financial circumstances, and problem-oriented dental attenders. CONCLUSIONS: In this diverse sample of adults, toothache pain occurs frequently and is quite variable overtime. Toothache occurs in conjunction with various forms of self-reported oral disease (e.g., abscess, cavities) or tissue damage (e.g., loose tooth, broken tooth, bleeding gums). Subjects who experience toothache are slightly more likely than others to utilize dental services in the time period proximate to the toothache pain.
Toothache is a common complaint in the dental office. Most toothaches have their origin in the pulpal tissues of periodontal structures. These odontogenic pains are managed well and predictably by dental therapies. Non-odontogenic toothaches are often difficult to identify and can challenge the diagnostic ability of the clinician. The most important step toward proper management of toothache is to be suspicious that the pain may not be of dental origin. The cardinal warning symptoms of non-odontogenic toothache are as follow: A. Spontaneous multiple toothaches. B. Inadequate local dental cause for the pain. C. Stimulating, burning, non-pulsatile toothaches. D. Constant, unremitting, non-variable toothaches. E. Persistent, recurrent toothaches. F. Local anesthetic blocking of the offending tooth does not eliminate the pain. G. Failure of the toothache to respond to reasonable dental therapy.
Toothache is a common complaint in the dental office. Most toothaches have their origin in the pulpal tissues or periodontal structures. These odontogenic pains are managed well and predictably by dental therapies. Nonodontogenic toothaches are often difficult to identify and can challenge the diagnostic ability of the clinician. The most important step towards proper management of toothache is to be suspicious that the pain may not be of dental origin. The cardinal warning symptoms of nonodontogenic toothache are as follows (28): a. spontaneous multiple toothaches; b. inadequate local dental cause for the pain; c. stimulating, burning, nonpulsatile toothaches; d. constant, unremitting, nonvariable toothaches; e. persistent, recurrent toothaches; f. local anesthetic blocking of the offending tooth does not eliminate the pain; and g. failure of the toothache to respond to reasonable dental therapy.
Toothache is a common complaint in the dental office. Most toothaches have their origin in the pulpal tissues or periodontal structures. These odontogenic pains are managed well and predictably by dental therapies. Nonodontogenic toothaches are often difficult to identify and can challenge the diagnostic ability of the clinician. The most important step toward proper management of toothache is to consider that the pain may not be of dental origin. Signs and symptoms suggestive of nonodontogenic toothache are as follows: 1. Inadequate local dental cause for the pain. 2. Stimulating, burning, nonpulsatile toothaches. 3. Constant, unremitting, nonvariable toothaches. 4. Persistent, recurrent toothaches over months or years. 5. Spontaneous multiple toothaches. 6. Local anesthetic blocking of the suspected tooth does not eliminate the pain. 7. Failure to respond to reasonable dental therapy of the tooth.
AIM: In the present study the value of the Dental Discomfort Questionnaire in predicting toothache in young children is analysed. METHODS: The Dental Discomfort Questionnaire (DDQ-8; Cronbach's alpha 0.75) was completed by parents on behalf of their children (N=99; mean age 47 months). Half of the children were referred to a special dental care centre and the other half were controls from a day care centre. RESULTS: The behaviours from the DDQ-8 appeared to be more often present in those children with decayed teeth and toothache than in those without decayed teeth or toothache. A score of 3 or higher on the DDQ-8 seemed the best cut-off point to predict toothache in children. The receiver operating characteristic curve (ROC) showed that the DDQ-8 has predictive value for toothache. STATISTICS: The validity of the DDQ-8 was expressed as sensitivity, specificity and positive predictive value and negative predictive value. The DDQ's ability to discriminate between patients with and without toothache was estimated by the area under the ROC area of the questionnaire. CONCLUSIONS: The DDQ-8 could be helpful for parents, non-dental healthcare workers and researchers in predicting the existence of toothache in preverbal children.
AIMS: To explore the subjective experience of a sample of patients attending a dental teaching hospital emergency clinic with toothache. MATERIALS AND METHODS: Subjects 21 female and 14 male dental patients, of different ages, marital status, employment status and levels of education, presenting with toothache at a dental teaching hospital emergency clinic. Data collection Unstructured in-depth interviews, following a topic guide. Analysis Transcribing, sifting, indexing and charting data according to key issues and themes. FINDINGS: A dimension of toothache pain that emerged was the perceived inability to cope. Patients reported a dependency on a dentist or other person to alleviate their pain, suggesting connotations of helplessness, disempowerment and incapacitation. The perceived inability to cope was also expressed in terms of loss of control, despair and isolation. A number of care-seeking patterns for toothache was identified: repeated visits to the same dentist for emergency care, repeated visits to different dentists, attendance at the dental hospital emergency clinic and consulting non-dental health workers such as doctors and pharmacists. CONCLUSIONS: The perceived inability to cope and care-seeking patterns are two unexplored dimensions of the toothache pain experience. Both dimensions may be associated with pain intensity, the clinical conditions that manifest as toothache, quality of treatment provided and management of demand for emergency dental care. A conceptual framework is proposed for future research to investigate these relationships.
Toothache is a subjective oral health indicator that should become uncommon when oral health is improving. The aim of this study was to assess changes in perceived toothache between 1977 and 1997 among Finnish adolescents. In the Adolescent Health and Lifestyle Survey, a self-administered questionnaire was mailed to a representative sample of 12-, 14-, 16-, and 18-year-old Finns every second year. The sample sizes in the surveys varied from 2422 to 11,105, making a total of 35,349 subjects in the entire study. The incidence of toothache during the previous 2 years was requested in 1977, 1985, 1991, 1995, and 1997, and the prevalences were 31%, 25%, 28%, 29%, and 37%, respectively. The increase between 1995 and 1997 was highest among 16- and 18-year-olds. There was no tendency for perceived toothache to decline over the study period, despite the decrease in caries experience. Toothache varied by age, socioeconomic status (SES), place of residence, and toothbrushing frequency. The increase in the incidence of toothache reported after 1995 could be a warning signal that economic recession in Finland has caused changes in the dental care system.
PURPOSE: This pilot study was conducted to estimate the prevalence of self-reported toothache, bleeding gums and oral ulcer experiences, reasons for dental visits and associated sociodemographic factors among adults living in Benin City, Edo State, Nigeria. MATERIALS AND METHODS: This cross-sectional study was based on a convenience sample in an urban setting. Out of the 540 persons surveyed, 508 had complete usable information, 48% males and 52% females, and aged 18 - 54 years. A closed questionnaire was used to collect the data at two large medical outpatient facilities and a university community. RESULTS: The proportion reporting toothache experience in the previous 12 months was 34%; painful/ bleeding gums 28%, and oral ulcers/painful spots 14%. Univariate analysis showed that toothache experience was associated with time since last dental visit (p < 0.001), age (p < 0.001), gender (p < 0.001) and education (p < 0.001). Experience with bleeding gums was associated with gender (p < 0.001), education (p < 0.001) and last dental visits (p < 0.001). Oral ulcers were associated with gender (p = 0.004), age (p < 0.001) and last dental visits (p < 0.001). Fewer males than females reported toothache (25% vs. 42%, OR 1.65) but more males reported bleeding gums (37% vs. 19%, OR = 0.34) and oral ulcers (19% vs. 10% OR = 0.33). CONCLUSIONS: Toothache experience was the most prevalent oral health problem reported by adults. Oral health problems were associated with age, gender and last dental visits.
Vasospastic angina was confirmed in a 13-year-old female patient at autopsy. The patient's only symptom was recurrent toothache, which began when she was 10 years old. In November 2000, she was evaluated at our medical center; however, all examinations were judged normal. Six months later, she suffered a severe toothache. She went to school the next morning after the symptoms improved. She lost consciousness at school and was given cardiopulmonary resuscitation but could not be revived. At autopsy, her three coronary vessels showed marked intimal hyperplasia, and multiple focal myocardial infarctions were observed in the lateral wall of the left ventricle. The patient's only clinical symptom was toothache and none of the physicians realized that this was caused by angina. Vasospastic angina begins at a young age and is one of the causes of sudden death in adolescents.
The aims of this study were to estimate the prevalence of missed dental appointments among Danish children at 6 to 8 years of age and to examine the association between dental anxiety, dental treatment due to toothache, and missed dental appointments in a population-based cross-sectional study. The study was conducted in four municipalities in the County of North Jutland, Denmark, and included a total of 1,235 children (response rate 74.1%). Data on missed dental appointments and toothache were obtained from dental records, and data on dental anxiety from the Children's Fear Survey Schedule-Dental Subscale. Overall, 37.7% of children missed one or more dental appointments, while 17.7% missed two or more appointments. These proportions did not differ by age or gender. Among children with dental anxiety, the adjusted OR for an association with two or more missed dental appointments was 1.32 (95% CI: 0.72-2.40), and among children who had dental treatment due to toothache, the adjusted OR of two or more missed dental appointments was 2.61 (95% CI: 1.63-4.18).
The relative severeness of toothache and two non-dental symptoms (headache, stomach complaints) was judged by men and women (n = 47). Each symptom was specified for two frequencies of occurrence (from time to time and regular) and two levels of intensity (minor and heavy). The methods used were paired comparisons and direct ranking of the 12 (3 X 2 X 2) verbal stimuli. Subjects were highly consistent in their pairwise choices. Agreement between judges was also highly significant. The overall ordering of the severity of the stimuli showed a perfect correspondence between the two methods. 'Heavy regular headache', 'heavy regular stomach complaints', and 'heavy regular toothache' were the three symptoms judged most severe. Headache, stomach complaints and toothache, specified as low on frequency and intensity, were judged least severe. Log-linear model fitting showed that the influence of intensity on the preference of a symptom is independent of the frequency of occurrence, and vice versa.
The purpose of this pilot investigation was to determine the usefulness of analgesic onset time as a measure of topical anesthetic efficacy in patients with spontaneous toothache pain. Under blinded conditions, 20 patients with spontaneous toothache pain from an open tooth cavity were randomly assigned to receive either 20% benzocaine or placebo (80% polyethylene glycol). The medication was applied directly to the open cavity in a volume of 3 drops. Patients then depressed a stop watch when they initially experienced pain relief. Patients who did not obtain relief were assigned the maximum onset value of 600 seconds. The average analgesic onset time was 111.8 seconds in the benzocaine group and 289.0 seconds in the placebo group. In the benzocaine group, 90% of the patients reported some pain relief, while a surprisingly high 60% reported some pain relief in the placebo group. The results of this study suggest that in the spontaneous toothache pain model, analgesic onset time is a valuable measure of topical anesthetic efficacy. In addition, polyethylene glycol at a concentration of 80% may not be a totally inactive vehicle.
The purpose of this investigation was to determine the efficacy of benzocaine for temporary relief of toothache. The agent used is available at drug counters; it contains 7.5 percent benzocaine in propylene glycol and has the form of a gel. The study was double blind. The agent and a placebo were provided by the manufacturer in an equal number of randomly numbered but otherwise unlabeled tubes. Forty-nine patients (twenty-five males and twenty-four females) with throbbing toothache pain resulting from dental caries were included in the study. The mean age was 25.6 years for patients receiving the drug and 26.7 years for patients receiving the placebo. Of the twenty-four patients who received the active agent, twenty (83 percent) were relieved of pain. The average time for onset of relief was 3.7 minutes. In the placebo group, only four patients (16 percent) were relieved of pain. When the chi-square test is used, the difference is statistically significant at the 0.01 level. No adverse reaction to the agents used was observed.
The McGill Pain Questionnaire (MPQ) was administered to 102 'toothache' patients to determine whether it was sufficiently sensitive to distinguish between dental patients whose pain was clinically diagnosed as originating from a reversibly inflamed tooth pulp (group I) and those whose pain was diagnosed as originating from an irreversibly inflamed or necrotic pulp (group II). Scores for Total Pain Rank Index (PRI(T)), Sensory Pain Rank Index (PRI(S)), Evaluative Pain Rank Index (PRI(E)), Miscellaneous Pain Rank Index (PRI(M)), and Number of Words Chosen (NWC) were significantly higher (p less than 0.05) for group II patients. The PRI differences between both groups were attributed mainly to the more frequent selection by group II patients of 8 of the 20 subclasses of words and/or of words with higher rank values within the 8 subclasses. A significantly greater degree of sleep disturbance, nausea, headache, drowsiness and/or dizziness was also found in group II patients. Discriminant analysis using the 20 subclasses and 4 supplementary questions related to sleep disturbance, changes in food intake or activity levels, and accompanying symptoms, indicated that the MPQ, when used alone, correctly predicted diagnosis and treatment outcome in 73% of patients. Therefore, our findings indicate that the MPQ can distinguish between the two types of toothache and suggest that, especially when used along with other standard diagnostic tests, it may be a useful clinical adjunct in the diagnosis of dental pain.
Last year was the bicentenary of the death of Robert Burns, who is Scotland's best known poet. January 25, Burns' birth date, is also a well-known celebration to the Scottish-the famous 'Burns Night'. Burns wrote many songs and poems, but his 'Address to the Toothache' is of particular interest to dentists. The poem provides a vivid account of one man's experience of toothache and gives an insight into how people regarded pain two hundred years ago.
Many teeth have been mistakenly extracted or endodontically treated because of an incorrect diagnosis of orofacial pain, including toothache. A case of persistent toothache originating from a malignant lymphoma of the left maxillary sinus is presented. Root canal therapy and extraction of the upper left quadrant teeth from the canine to the second molar did not resolve the chief complaint. The patient was referred to a neurologist and received a diagnosis of a malignant lymphoma, a rare lesion of the maxillary sinus. This case stresses the importance of considering malignant neoplasm of the maxillary sinus as a potential etiologic factor in the differential diagnosis of orofacial pain.
Benign cough headache (BCH) presents as an intermittent, usually bilateral, severe bursting or explosive pain brought on by coughing. Some of the known conditions which can mimic the pain experienced in BCH are subarachnoid hemorrhage, increased intracranial pressure, intracranial tumors, and even toothache. Careful evaluation must be carried out in order to differentiate between these conditions. A case of BCH which presented as a toothache is reported. The evaluation for exertional headaches, and for headaches brought on by coughing, is discussed.