1
|
See LP, Sripinun P, Lu W, Li J, Alboloushi N, Alvarez-Periel E, Lee SM, Karabucak B, Wang S, Jordan Sciutto KL, Theken KN, Mitchell CH. Increased Purinergic Signaling in Human Dental Pulps With Inflammatory Pain is Sex-Dependent. THE JOURNAL OF PAIN 2024; 25:1039-1058. [PMID: 37956743 PMCID: PMC11129867 DOI: 10.1016/j.jpain.2023.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/22/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023]
Abstract
An enhanced understanding of neurotransmitter systems contributing to pain transmission aids in drug development, while the identification of biological variables like age and sex helps in the development of personalized pain management and effective clinical trial design. This study identified enhanced expression of purinergic signaling components specifically in painful inflammation, with levels increased more in women as compared to men. Inflammatory dental pain is common and potentially debilitating; as inflammation of the dental pulp can occur with or without pain, it provides a powerful model to examine distinct pain pathways in humans. In control tissues, P2X3 and P2X2 receptors colocalized with PGP9.5-positive nerves. Expression of the ecto-nucleotidase NTPDase1 (CD39) increased with exposure to extracellular adenosine triphosphate (ATP), implying CD39 acted as a marker for sustained elevation of extracellular ATP. Both immunohistochemistry and immunoblots showed P2X2, P2X3, and CD39 increased in symptomatic pulpitis, suggesting receptors and the ATP agonist were elevated in patients with increased pain. The increased expression of P2X3 and CD39 was more frequently observed in women than men. In summary, this study identifies CD39 as a marker for chronic elevation of extracellular ATP in fixed human tissue. It supports a role for increased purinergic signaling in humans with inflammatory dental pain and suggests the contribution of purines shows sexual dimorphism. This highlights the potential for P2X antagonists to treat pain in humans and stresses the need to consider sex in clinical trials that target pain and purinergic pathways. PERSPECTIVE: This article demonstrates an elevation of ATP-marker CD39 and of ATP receptors P2X2 and P2X3 with inflammatory pain and suggests the rise is greater in women. This highlights the potential for P2X antagonists to treat pain and stresses the consideration of sexual dimorphism in studies of purines and pain.
Collapse
Affiliation(s)
- Lily P. See
- Departments of Basic and Translational Science, University of Pennsylvania, Philadelphia, PA 19104
- Department of Endodontics, University of Pennsylvania, Philadelphia, PA 19104
| | - Puttipong Sripinun
- Departments of Basic and Translational Science, University of Pennsylvania, Philadelphia, PA 19104
- Department of Orthodontics, University of Pennsylvania, Philadelphia, PA 19104
| | - Wennan Lu
- Departments of Basic and Translational Science, University of Pennsylvania, Philadelphia, PA 19104
| | - Jiaqi Li
- Departments of Basic and Translational Science, University of Pennsylvania, Philadelphia, PA 19104
| | - Naela Alboloushi
- Department of Endodontics, University of Pennsylvania, Philadelphia, PA 19104
- Department of Oral Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | | | - Su-Min Lee
- Department of Endodontics, University of Pennsylvania, Philadelphia, PA 19104
| | - Bekir Karabucak
- Department of Endodontics, University of Pennsylvania, Philadelphia, PA 19104
| | - Steven Wang
- Department of Oral Surgery, University of Pennsylvania, Philadelphia, PA 19104
| | | | - Katherine N. Theken
- Department of Oral Surgery, University of Pennsylvania, Philadelphia, PA 19104
| | - Claire H. Mitchell
- Departments of Basic and Translational Science, University of Pennsylvania, Philadelphia, PA 19104
- Department of Physiology, University of Pennsylvania, Philadelphia, PA 19104
| |
Collapse
|
2
|
Lillis KV, Grinceviciute R, Diogenes A. Sex-specific nociceptor modulation of the apical periodontitis transcriptome. Front Mol Biosci 2024; 11:1338511. [PMID: 38404963 PMCID: PMC10884291 DOI: 10.3389/fmolb.2024.1338511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/15/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction: Apical periodontitis (AP) is a painful disease that develops quickly following dental infections and is primarily characterized by robust inflammation surrounding the tissues of the affected tooth, resulting in disruption of bone homeostasis and periradicular bone loss. Moreover, there are distinct clinical presentations, symptoms, and responses to AP treatment between male and female subjects, creating a desperate need to further understand the sex-specific mechanisms of AP. Methods: With the growing evidence that nociceptors modulate AP development, we utilized RNA sequencing in nociceptor-ablated (Nav1.8 cre+/-, diphtheria toxin Alox+/-) transgenic mice to study the nociceptor regulation of the periapical lesion transcriptome using a rodent model of AP in female mice over 14 days. Results: Overall, we found that female mice exhibit unique patterns of differentially expressed genes throughout AP infection compared to male mice and that the expression of these genes is regulated by nociceptors. Additionally, nociceptor ablation results in a more significant enrichment of biological processes related to immune responses earlier compared to cre-control (Nav1.8 cre+/-) females and greater expression of genes involved in inflammatory processes and osteolytic activity. Discussion: Therefore, while nociceptor ablation augments inflammatory and bone resorption responses in both males and females in a mouse model of AP, transcriptomic analyses demonstrate that the mechanisms through which nociceptors modulate AP are distinct between sexes. These studies will provide the foundation needed to study further mechanisms of sex differences in AP, an area with a desperate need for investigation to treat current AP patients. Understanding these mechanisms can ultimately inform treatment options to alleviate suffering for millions of patients suffering from AP.
Collapse
Affiliation(s)
| | | | - Anibal Diogenes
- Department of Endodontics, University of Texas Health at San Antonio, San Antonio, TX, United States
| |
Collapse
|
3
|
Sangalli L, Souza LC, Letra A, Shaddox L, Ioannidou E. Sex as a Biological Variable in Oral Diseases: Evidence and Future Prospects. J Dent Res 2023; 102:1395-1416. [PMID: 37967405 DOI: 10.1177/00220345231197143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
The interest of the scientific community on sex and gender differences in health and disease has increased substantially over the past 25 to 30 y as a result of a long process of events and policies in the biomedical field. This is crucial as compelling evidence from human and animal model studies has demonstrated that sex and gender influence health, molecular and cellular processes, and response and predisposition to disease. The present scoping review aims to provide a synthesis of sex differences in oral diseases, ranging from periodontal disease to orofacial pain conditions, from risk of caries development to apical periodontitis. Overall, findings from this review further support a role for sexual dimorphism influencing disease predisposition and/or progression in oral diseases. Of note, this review also highlights the lack of consideration of additional factors such as gender and other psychosocial and external factors potentially influencing oral health and disease. New conceptual frameworks capable of capturing multiple fundamental domains and measurements should be developed in clinical and preclinical studies to inform sex-based individualized preventive and treatment strategies.
Collapse
Affiliation(s)
- L Sangalli
- College of Dental Medicine-Illinois, Midwestern University, Downers Grove, IL, USA
| | - L C Souza
- Center for Craniofacial Research, Department of Endodontics, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - A Letra
- Departments of Oral and Craniofacial Sciences, Endodontics, and Center for Craniofacial and Dental Genetics, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, USA
| | - L Shaddox
- Center for Oral Health Research, Division of Periodontology, University of Kentucky, College of Dentistry, Lexington, KY, USA
| | - E Ioannidou
- UCSF, Department of Orofacial Sciences, San Francisco, CA, USA
| |
Collapse
|
4
|
Laks EY, Li H, Ward SJ. Non-Psychoactive Cannabinoid Modulation of Nociception and Inflammation Associated with a Rat Model of Pulpitis. Biomolecules 2023; 13:biom13050846. [PMID: 37238715 DOI: 10.3390/biom13050846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Despite advancements in dental pain management, one of the most common reasons for emergency dental care is orofacial pain. Our study aimed to determine the effects of non-psychoactive Cannabis constituents in the treatment of dental pain and related inflammation. We tested the therapeutic potential of two non-psychoactive Cannabis constituents, cannabidiol (CBD) and β-caryophyllene (β-CP), in a rodent model of orofacial pain associated with pulp exposure. Sham or left mandibular molar pulp exposures were performed on Sprague Dawley rats treated with either vehicle, the phytocannabinoid CBD (5 mg/kg i.p.) or the sesquiterpene β-CP (30 mg/kg i.p.) administered 1 h pre-exposure and on days 1, 3, 7, and 10 post-exposure. Orofacial mechanical allodynia was evaluated at baseline and post-pulp exposure. Trigeminal ganglia were harvested for histological evaluation at day 15. Pulp exposure was associated with significant orofacial sensitivity and neuroinflammation in the ipsilateral orofacial region and trigeminal ganglion. β-CP but not CBD produced a significant reduction in orofacial sensitivity. β-CP also significantly reduced the expression of the inflammatory markers AIF and CCL2, while CBD only decreased AIF expression. These data represent the first preclinical evidence that non-psychoactive cannabinoid-based pharmacotherapy may provide a therapeutic benefit for the treatment of orofacial pain associated with pulp exposure.
Collapse
Affiliation(s)
- Elana Y Laks
- Department of Prosthodontics, School of Dentistry, Indiana University, Indianapolis, IN 46202, USA
| | - Hongbo Li
- Center for Substance Abuse Research, Department of Neural Sciences, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Sara Jane Ward
- Center for Substance Abuse Research, Department of Neural Sciences, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| |
Collapse
|
5
|
Sooratgar A, Khavanin N, Dibaji F, Asadi Y, Kharazifard M. Evaluation of the Effect of Common Analgesics on Pulpal Sensibility Tests: A Clinical Trial. J Endod 2023; 49:362-368. [PMID: 36657522 DOI: 10.1016/j.joen.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 01/07/2023] [Accepted: 01/07/2023] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Accurate diagnosis is one of the most important steps before endodontic treatment. The aim of this study was to assess the effect of 2 commonly used analgesics namely ibuprofen and acetaminophen on the cold and electric pulp test (EPT) results in participants with symptomatic irreversible pulpitis (SIP). METHODS This clinical trial evaluated 41 participants with pain due to SIP. The cold test and EPT were performed for teeth with SIP, and also for the corresponding tooth with healthy pulp in the contralateral quadrant. The participants then received 500 mg acetaminophen, 400 mg ibuprofen, or the placebo in the 3 groups. The cold test and EPT were repeated at 20, 40, and 60 minutes after medication intake, and the results were compared with the pretreatment values. RESULTS In the acetaminophen group, the results of cold test significantly decreased 40 (P < .05), and 60 (P < .05) minutes after analgesic intake in teeth with SIP and after 40 minutes (P < .05) in the corresponding contralateral teeth with healthy pulp. In the ibuprofen group, the cold test results significantly decreased at 20 (P < .05), 40 (P < .05), and 60 (P < .05) minutes after analgesic intake in teeth with SIP and after 40 minutes (P < .05) in the corresponding contralateral teeth with healthy pulp. The EPT results were not significantly affected by the studied analgesics at any time point (P > .05). There was no significant difference among the study groups regarding sex (P > .05). CONCLUSION It appears that both acetaminophen and ibuprofen can affect the pulpal response to the cold sensibility test. However, the studied medications had no significant effect on the EPT results. Therefore, dental clinicians should be aware of the possible effects of such medications on the cold test response.
Collapse
Affiliation(s)
- Aidin Sooratgar
- Department of Endodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Fatemeh Dibaji
- Department of Endodontics, School of Dentistry (International Campus), Tehran University of Medical Sciences, Tehran, Iran.
| | - Yasin Asadi
- Department of Periodontics, School of Dentistry, AJA University of Medical Sciences, Tehran, Iran
| | - Mohammadjavad Kharazifard
- Department of Epidemiology, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
6
|
Habib MFOM, Tarek S, Teama SME, Ezzat K, El Boghdadi RM, Marzouk A, Fouda MY, Gawdat SI, Bedier MM, Amin SAW. Inferior Alveolar Nerve Block Success of 2% Mepivacaine versus 4% Articaine in Patients with Symptomatic Irreversible Pulpitis in Mandibular Molars: A Randomized Double-Blind Single-Centre Clinical Trial. Int Endod J 2022; 55:1177-1189. [PMID: 35947082 DOI: 10.1111/iej.13810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 11/27/2022]
Abstract
AIM To assess inferior alveolar nerve block (IANB) success of 2% mepivacaine (Scandonest 2%, Septodont, France) and 4% articaine (Septanest 4%, Septodont) in patients with symptomatic irreversible pulpitis (SIP) in mandibular molars during access cavity preparation and instrumentation. METHODOLOGY Three hundred and thirty patients with moderate-to-severe pain in mandibular molars with SIP randomly received either 3.6 mL 2% mepivacaine hydrochloride with 1:100 000 adrenalin or 3.4mL 4% articaine hydrochloride with 1:100 000 adrenalin (n=165). Intraoperative pain (IOP) intensity was assessed during access cavity preparation and canal instrumentation using 11-point numerical rating scale (NRS). Overall success was considered if the patient felt no-to-mild pain without the need of supplemental anaesthesia throughout treatment; the incidence of need for supplemental anaesthesia was also recorded. Data were statistically analyzed using Mann Whitney U and Chi2 (χ2 ) tests. Relative risk (RR) and 95% confidence interval (CI) of anaesthetic failure was calculated. The effect of predisposing factors on outcome variables was assessed using multivariable regression analyses. None of the participants reported any adverse effects. RESULTS Baseline variables were balanced between groups (p>0.05). The IOP intensity during access cavity preparation and canal instrumentation was similar for both groups (p>0.05). IOP intensity was associated with preoperative pain intensity and tooth type (p<0.05). Overall anaesthetic success rate was 35.8% for mepivacaine and 41.2% for articaine (p>0.05) with a relative risk of failure [95%CI] 1.09 [0.92, 1.30]. The need for supplemental anaesthesia occurred 43.6% and 38.2% with mepivacaine and articaine respectively (p>0.05; RR [95%CI]: 1.14 [0.88, 1.48]). Preoperative pain level and age were associated with the need for supplemental anaesthesia. CONCLUSIONS 2% mepivacaine and 4% articaine demonstrate similar IANB success rates for mandibular molars with SIP. Intraoperative pain experience during endodontic treatment can be associated with preoperative pain, tooth type and age.
Collapse
Affiliation(s)
- M F O M Habib
- Department of Endodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - S Tarek
- Department of Endodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - S M E Teama
- Department of Endodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - K Ezzat
- Department of Endodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - R M El Boghdadi
- Department of Endodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - A Marzouk
- Department of Endodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - M Y Fouda
- Department of Endodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - S I Gawdat
- Department of Endodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - M M Bedier
- Department of Endodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - S A W Amin
- Department of Endodontics, Faculty of Dentistry, Cairo University, Cairo, Egypt
| |
Collapse
|
7
|
Ali SA, Ansari WE. Is tele-diagnosis of dental conditions reliable during COVID-19 pandemic? Agreement between tentative diagnosis via synchronous audioconferencing and definitive clinical diagnosis. J Dent 2022; 122:104144. [PMID: 35487287 PMCID: PMC9040478 DOI: 10.1016/j.jdent.2022.104144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/23/2022] [Accepted: 04/21/2022] [Indexed: 11/28/2022] Open
Abstract
Objectives To assess the reliability of synchronous audioconferencing teledentistry (TD) in making tentative diagnosis compared to definitive clinical face-to-face (CFTF) diagnosis; and whether agreement was influenced by dentist's experience, caller-patient relationship, and time of call. Methods All patients calling the TD hotline during COVID-19 pandemic, triaged as emergency/ urgent and referred for CFTF care were included (N=191). Hotline dentists triaged the calls, made tentative audio-dentistry (AD) diagnosis, while dentists at point of referral made the definitive CFTF diagnosis. Cohen's weighted kappa (κ) assessed the extent of agreement between AD vs CFTF diagnosis. Results There was significantly very good pair-wise agreement (κ = 0.853, P < 0.0001) between AD and CFTF diagnosis. AD diagnosis of pulpitis and periodontitis exhibited the most frequent disagreements. Tele-dentists with ≥ 20 years’ experience exhibited the highest level of agreement (κ =0.872, P < 0.0001). There was perfect agreement when mothers mediated the call (κ = 1, P < 0.0001), and very good agreement for calls received between 7 am-2 pm (κ = 0.880, P < 0.0001) compared to calls received between 2-10 pm (κ = 0.793, P < 0.0001). Conclusions Remote tentative diagnosis using AD is safe and reliable. Reliability was generally very good but varied by dentist's experience, caller-patient relationship, and time of call. Clinical significance The findings suggest that using AD in the home environment is safe and reliable, deploying providers with variable years of experience. The findings have generalizability potential to a variety of similar circumstances, healthcare settings and epi/pandemic situations.
Collapse
Affiliation(s)
- Shaymaa Abdulreda Ali
- Unit of Orthodontics, Hamad Dental Center, Hamad Medical Corporation, Doha, Qatar; University of Aberdeen, King's College, Aberdeen, AB24 3FX, UK.
| | - Walid El Ansari
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar; College of Medicine, Qatar University, Doha, Qatar; Weill Cornell Medicine, Qatar, Doha, Qatar; School of Health and Education, University of Skovde, Skovde, Sweden.
| |
Collapse
|
8
|
Erdogan O, Malek M, Gibbs JL. Associations between Pain Severity, Clinical Findings, and Endodontic Disease: A Cross-Sectional Study. J Endod 2021; 47:1376-1382. [PMID: 34256059 DOI: 10.1016/j.joen.2021.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/25/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Thorough pain assessment and thermal and mechanical testing are the primary diagnostic tools used to assess the status of pulp and periapical tissues in teeth with potential endodontic pathology. This study evaluated predictors of acute odontogenic pain to better understand the relationship between endodontic pain, clinical testing, endodontic disease, and diagnoses. METHODS Participants (N = 228) presenting with acute odontogenic pain underwent standardized clinical testing and reported their pain intensity. Univariate and multiple regression analyses were performed to evaluate the predictors of acute endodontic pain. Chi-square tests with Bonferroni adjustments were conducted to measure the frequency of endodontic diagnostic test findings and clinical observations in patients with different pulpal diagnoses. RESULTS A negative response to cold stimulation on the causative tooth and percussion hypersensitivity on the healthy adjacent tooth were the strongest predictors of higher levels of acute endodontic pain. Percussion hypersensitivity on the healthy adjacent tooth was present in a quarter of the cohort and was reported with equal frequency in teeth diagnosed with irreversible pulpitis, necrotic pulp, and previously initiated/treated teeth. Although painful percussion on the causative tooth was more frequently reported in teeth diagnosed with necrotic pulp, painful palpation was more frequently reported on teeth diagnosed with previously initiated/treated teeth. CONCLUSIONS Percussion hypersensitivity on the healthy adjacent tooth may reveal a lowered pain threshold and heightened pain sensitization. It is also possible that the 2 commonly performed mechanical sensory tests, percussion and palpation hypersensitivity, may detect different aspects of endodontic pathophysiology and pain processing.
Collapse
Affiliation(s)
- Ozge Erdogan
- Division of Endodontics in Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Massachusetts; Department of Endodontics, New York University, College of Dentistry, New York, New York.
| | - Matthew Malek
- Department of Endodontics, New York University, College of Dentistry, New York, New York
| | - Jennifer L Gibbs
- Division of Endodontics in Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Massachusetts; Department of Endodontics, New York University, College of Dentistry, New York, New York
| |
Collapse
|
9
|
Ribeiro-Santos FR, Arnez MFM, de Carvalho MS, da Silva RAB, Politi MPL, de Queiroz AM, Nelson-Filho P, da Silva LAB, Faccioli LH, Paula-Silva FWG. Effect of non-steroidal anti-inflammatory drugs on pulpal and periapical inflammation induced by lipopolysaccharide. Clin Oral Investig 2021; 25:6201-6209. [PMID: 33791868 DOI: 10.1007/s00784-021-03919-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/28/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate the effect of non-steroidal anti-inflammatory drugs (NSAIDs) in controlling pulpal and periapical inflammation in vivo as a potential coadjutant systemic therapy for pulpitis. MATERIALS AND METHODS A suspension containing E. coli lipopolysaccharide (LPS; 1.0 μg/μL) was inoculated into the pulp chamber of the first molars of C57BL/6 mice (n = 72), and the animals were treated daily with indomethacin or celecoxib throughout the experimental periods. After 7, 14, 21, and 28 days, the tissues were removed for histopathological, histoenzymology, histometric, and immunohistochemical evaluation. RESULTS Inoculation of LPS into the pulp chamber induced the synthesis of the enzyme cyclooxygenase-2 (COX-2) in dental pulp and periapical region. Indomethacin and celecoxib treatment changed the profile of inflammatory cells recruited to dental pulp and to the periapex, which was characterized by a higher mononuclear cell infiltrate, compared to LPS inoculation alone which recruited a higher amount of polymorphonuclear neutrophils. Administration of indomethacin for 28 days resulted in the development of apical periodontitis and increased osteoclast recruitment, unlike celecoxib. CONCLUSIONS NSAIDs indomethacin and celecoxib changed the recruitment of inflammatory cells to a mononuclear profile upon inoculation of LPS into the pup chamber, but indomethacin enhanced periapical bone loss whereas celecoxib did not. CLINICAL RELEVANCE Celecoxib, a selective COX-2 inhibitor, can change the profile of inflammatory cells recruited to the dental pulp challenged with LPS and might a be potential systemic coadjutant for treatment of pulpitis.
Collapse
Affiliation(s)
- Fernanda Regina Ribeiro-Santos
- School of Dentistry of Ribeirão Preto, University of São Paulo, Avenida do Café, s/n. CEP 14040-904, Ribeirão Preto, São Paulo, Brazil
- Universidade de Pernambuco, Arco Verde, Pernambuco, Brazil
| | - Maya Fernanda Manfrin Arnez
- School of Dentistry of Ribeirão Preto, University of São Paulo, Avenida do Café, s/n. CEP 14040-904, Ribeirão Preto, São Paulo, Brazil
| | - Marcio Santos de Carvalho
- School of Dentistry of Ribeirão Preto, University of São Paulo, Avenida do Café, s/n. CEP 14040-904, Ribeirão Preto, São Paulo, Brazil
| | - Raquel Assed Bezerra da Silva
- School of Dentistry of Ribeirão Preto, University of São Paulo, Avenida do Café, s/n. CEP 14040-904, Ribeirão Preto, São Paulo, Brazil
| | - Marília Pacífico Lucisano Politi
- School of Dentistry of Ribeirão Preto, University of São Paulo, Avenida do Café, s/n. CEP 14040-904, Ribeirão Preto, São Paulo, Brazil
| | - Alexandra Mussolino de Queiroz
- School of Dentistry of Ribeirão Preto, University of São Paulo, Avenida do Café, s/n. CEP 14040-904, Ribeirão Preto, São Paulo, Brazil
| | - Paulo Nelson-Filho
- School of Dentistry of Ribeirão Preto, University of São Paulo, Avenida do Café, s/n. CEP 14040-904, Ribeirão Preto, São Paulo, Brazil
| | - Léa Assed Bezerra da Silva
- School of Dentistry of Ribeirão Preto, University of São Paulo, Avenida do Café, s/n. CEP 14040-904, Ribeirão Preto, São Paulo, Brazil
| | - Lúcia Helena Faccioli
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Francisco Wanderley Garcia Paula-Silva
- School of Dentistry of Ribeirão Preto, University of São Paulo, Avenida do Café, s/n. CEP 14040-904, Ribeirão Preto, São Paulo, Brazil.
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil.
| |
Collapse
|
10
|
Patel B, Eskander MA, Ruparel NB. To Drill or Not to Drill: Management of Endodontic Emergencies and In-Process Patients during the COVID-19 Pandemic. J Endod 2020; 46:1559-1569. [PMID: 32841654 PMCID: PMC7443083 DOI: 10.1016/j.joen.2020.08.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/23/2020] [Accepted: 08/06/2020] [Indexed: 11/17/2022]
Abstract
Introduction Dental professionals are at high risk of contracting coronavirus disease 2019 (COVID-19) infection because of their scope of practice with aerosol-generating procedures. Recommendation by the Centers for Disease Control and Prevention to suspend elective dental procedures and avoid aerosol-generating procedures posed significant challenges in the management of patients presenting with endodontic emergencies and uncertainty of outcomes for endodontic procedures initiated, but not completed, before shutdown. The purpose of this study was to evaluate the success of palliative care on endodontic emergencies during the COVID-19 pandemic and to evaluate the stability of teeth with long-term Ca(OH)2 placement because of delays in treatment completion. Methods Patients presenting for endodontic emergencies during COVID-19 Shelter-in-Place orders received palliative care, including pharmacologic therapy and/or non–aerosol-generating procedural interventions. Part I of the study evaluated the effectiveness of palliative care, and need for aerosol-generating procedures or extractions was quantified. Part II of the study evaluated survivability and rate of adverse events for teeth that received partial or full root canal debridement and placement of calcium hydroxide before shutdown. Results Part I: Twenty-one patients presented with endodontic emergencies in 25 teeth during statewide shutdown. At a follow-up rate of 96%, 83% of endodontic emergencies required no further treatment or intervention after palliative care. Part II: Thirty-one teeth had received partial or full root canal debridement before statewide shutdown. Mean time to complete treatment was 13 weeks. At a recall rate of 100%, 77% of teeth did not experience any adverse events due to delays in treatment completion. The most common adverse event was a fractured provisional restoration (13%), followed by painful and/or infectious flare-up (6.4%), which were managed appropriately and therefore seemed successful. Only 1 tooth was fractured and nonrestorable (3%), leading to a failed outcome of tooth extraction. The remaining 4 outcome failures (13%) were due to patient unwillingness to undergo school-mandated COVID testing or patient unwillingness to continue treatment because of perceived risk of COVID infection. Conclusions Palliative care for management of endodontic emergencies is a successful option when aerosol-generating procedures are restricted. This treatment approach may be considered in an effort to reduce risk of transmission of COVID-19 infection during subsequent shutdowns. Prolonged Ca(OH)2 medicament because of COVID-19 related delays in treatment completion appeared to have minimal effect on survival of teeth.
Collapse
Affiliation(s)
- Biraj Patel
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Michael A Eskander
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Nikita B Ruparel
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
| |
Collapse
|
11
|
Effect of Pulpotomy Procedures With Mineral Trioxide Aggregate and Dexamethasone on Post-endodontic Pain in Patients with Irreversible Pulpitis: A Randomized Clinical Trial. Eur Endod J 2020; 4:69-74. [PMID: 32161890 PMCID: PMC7006548 DOI: 10.14744/eej.2019.91885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 04/03/2019] [Indexed: 11/24/2022] Open
Abstract
Objective: Endodontic post-treatment pain continues to be one of the main problems encountered by dental professionals. Therefore, pain control during and after endodontic treatment is one of the most important issues in endodontics. The purpose of this clinical trial was to compare postoperative pain relief achieved with dexamethasone (DEX) and mineral trioxide aggregate (MTA) used as pulp coverage after pulpotomy in human molars with irreversible pulpitis. Methods: This prospective double-blind study was conducted on 54 patients complaining of dental pain due to irreversible pulpitis. The standard pulpotomy procedure was performed by the same dentist in all patients. At the time of the cotton pellet placement, patients were randomly divided into three groups: those in whom a sterile dry cotton (DC) pellet was used, patients treated with a cotton pellet soaked in MTA, and those who were treated with a cotton pellet soaked in DEX. After completion of the treatment, patients received rescue medication every 6 hours for the first day. Postoperative pain was assessed at 6-hour intervals for 24 hours, and then every day until day 7 using a visual analog scale. Results: In general, patients treated with MTA suffered the lowest levels of pain at all time intervals. Post-pulpotomy pain was significantly reduced at 18 and 24 hours and from days 2 to 7 post-treatment in the MTA group. DEX lowered the pain level more than the DC pellet. However, the differences observed in the mean pain scores of the DEX and DC pellet groups at all-time intervals were not statistically significant. Conclusion: Pulpotomy procedures can reduce pain related irreversible pulpitis. Pulpotomy with MTA-soaked cotton pellet significantly reduces pain intensity in patients with irreversible pulpitis.
Collapse
|
12
|
Mohaved SB, Shilpa G, Li Q, Austah O, Bendele M, Brock R, Ruparel NB. Apical periodontitis-induced mechanical allodynia: A mouse model to study infection-induced chronic pain conditions. Mol Pain 2020; 16:1744806919900725. [PMID: 31902318 PMCID: PMC6977224 DOI: 10.1177/1744806919900725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Infection-induced chronic pain is an under-studied pain condition. One example is apical periodontitis, which evokes considerable mechanical allodynia that persists after treatment in 7% to 12% of patients. Available analgesics often provide incomplete relief. However, a preclinical model to study pain mechanisms associated with apical periodontitis is not available. Here, we report a mouse model of apical periodontitis to facilitate studies determining mechanisms mediating persistent infection-induced pain. Mice were anesthetized and the left first molar was exposed to the oral environment for six weeks. Bone resorption, as an indicator of apical periodontitis, was quantified using microcomputed tomography. Mechanical allodynia was determined using extraoral von-Frey filaments in both male and female mice. The expression of c-fos in the medullary dorsal horn was assessed using immunohistochemistry. Mice with apical periodontitis developed significant mechanical allodynia by day 7 that was maintained for 42 days. Mechanical thresholds were significantly lower in females compared to males. Administration of ibuprofen, morphine, or MK-801 reversed mechanical allodynia. Finally, apical periodontitis triggered an upregulation of c-fos in the medullary dorsal horn. Collectively, this model simulates signs of clinical pain experienced by patients with apical periodontitis, detects sex differences in allodynia, and permits the study of peripheral and central trigeminal pain mechanisms.
Collapse
Affiliation(s)
- Saeed B Mohaved
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Ganatra Shilpa
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Qun Li
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Obadah Austah
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Michelle Bendele
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Robert Brock
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Nikita B Ruparel
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| |
Collapse
|
13
|
Erdogan O, Malek M, Janal MN, Gibbs JL. Sensory testing associates with pain quality descriptors during acute dental pain. Eur J Pain 2019; 23:1701-1711. [DOI: 10.1002/ejp.1447] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 06/22/2019] [Accepted: 06/23/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Ozge Erdogan
- Department of Endodontics New York University College of Dentistry New York New York
- Department of Endodontics Faculty of Dentistry, Hacettepe University Ankara Turkey
| | - Matthew Malek
- Department of Endodontics New York University College of Dentistry New York New York
| | - Malvin N. Janal
- Department of Epidemiology and Health Promotion New York University College of Dentistry New York New York
| | - Jennifer L. Gibbs
- Department of Endodontics New York University College of Dentistry New York New York
- Department of Restorative Dentistry and Biomaterials Sciences Harvard School of Dental Medicine Boston Massachusetts
| |
Collapse
|
14
|
Abstract
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 number of dentists continue to prescribe antibiotics to stop the pain of irreversible pulpitis.This review updates the previous version published in 2016. OBJECTIVES To assess the effects of systemic antibiotics for irreversible pulpitis. SEARCH METHODS We searched Cochrane Oral Health's Trials Register (to 18 February 2019); the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 1) in the Cochrane Library (searched 18 February 2019); MEDLINE Ovid (1946 to 18 February 2019); Embase Ovid (1980 to 18 February 2019); US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov (searched 18 February 2019); and the World Health Organization International Clinical Trials Registry Platform (searched 18 February 2019). There were no language restrictions in the searches of the electronic databases. SELECTION CRITERIA Randomised controlled trials 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 Three review authors screened studies and extracted data independently. We assessed the certainty of the evidence of included studies using GRADE. Pooling of data was not possible and a descriptive summary is presented. MAIN RESULTS No additional trials could be included in this update. One trial at low risk of bias evaluating oral penicillin in combination with analgesics versus placebo with analgesics, involving 40 participants was included in a former update of the review. The certainty of the evidence was rated low for the different outcomes. Our primary outcome was patient-reported pain (intensity/duration) and pain relief. There was a close parallel distribution of the pain ratings in both the intervention (median 6.0, interquartile range (IQR) 10.5), and for placebo (median 6.0, IQR 9.5) over the seven-day study period. There was insufficient evidence to claim or refute a benefit for penicillin for pain intensity. There was no significant difference in the mean total number of ibuprofen tablets over the study period: 9.20 (standard deviation (SD) 6.02) in the penicillin group versus 9.60 (SD 6.34) in the placebo group; mean difference -0.40 (95% confidence interval (CI) -4.23 to 3.43; P = 0.84). This applied equally for the mean total number of Tylenol tablets: 6.90 (SD 6.87) used in the penicillin group versus 4.45 (SD 4.82) in the placebo group; mean difference 2.45 (95% CI -1.23 to 6.13; P = 0.19). Our secondary outcome on reporting of adverse events was not addressed in this study. AUTHORS' CONCLUSIONS This Cochrane Review which was based on one low-powered small sample trial assessed as at low risk of bias, illustrates that there is insufficient evidence to determine whether antibiotics reduce pain or not compared to not having antibiotics. The results of this review confirm the necessity for further larger sample and methodologically sound trials that can provide additional evidence as to whether antibiotics, prescribed in the preoperative phase, can affect treatment outcomes for irreversible pulpitis.
Collapse
Affiliation(s)
| | | | | | - Esther J van Zuuren
- Leiden University Medical CenterDepartment of DermatologyPO Box 9600B1‐QLeidenNetherlands2300 RC
| | - Julie Sprakel
- University of Sao PauloDepartment of Gynecology and Obstetrics, Ribeiro Preto Medical SchoolSao PauloBrazil
| | | |
Collapse
|
15
|
Effects of Ibuprofen Compared to Other Premedication Drugs on the Risk and Intensity of Postendodontic Pain: A Systematic Review. Eur Endod J 2018; 3:123-133. [PMID: 32161868 PMCID: PMC7006579 DOI: 10.14744/eej.2018.83803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 07/12/2018] [Accepted: 08/10/2018] [Indexed: 11/20/2022] Open
Abstract
Objective This systematic review aims to evaluate the effects of ibuprofen compared to other drugs on the risk and intensity of postoperative pain resulting from endodontic treatment in adult patients. Methods A systematic search was carried out through Medline databases (Pubmed, Scopus, Web of Science, Cochrane, Lilacs, and BBO). There was no restriction on the publication year or idiom. The gray literature was explored. The Periodicos Capes Theses Databases and ProQuest Dissertations were also searched, as well as the unpublished and ongoing trials registry and the IADR abstracts (1990-2016). Solely randomized clinical trials that compared the risk or intensity of pain resulting from endodontic treatment in adult patients were included in this systematic review. The risk of bias of the articles was evaluated using the Cochrane Collaboration's tool. A random-effect meta-analysis was conducted for ibuprofen versus placebo and ibuprofen versus other drugs at 6, 8, and 24 hours. The GRADE approach was used to assess the quality of the evidence. Results A total of 1132 studies were identified, and only seven meet the eligibility criteria. No difference between the groups was detected in any of the meta-analysis. An exception was observed when one study was removed from the meta-analysis of pain intensity at 24 hours for ibuprofen versus placebo, favoring ibuprofen (SMD -0.67; 95% CI -1.05 to -0.17). The quality of evidence in all meta-analyses was graded as low or very low. Conclusion Results of the present systematic review indicate that there is no clear evidence supporting that preoperative ibuprofen is better than other drugs in reducing the risk and intensity of postendodontic pain.
Collapse
|
16
|
Sakhaeimanesh V, Khazaei S, Kaviani N, Saatchi M, Shafiei M, Khademi A. Anesthetic Efficacy of Articaine and Ketamine for Inferior Alveolar Nerve Block in Symptomatic Irreversible Pulpitis: A Prospective Randomized Double-Blind Study. IRANIAN ENDODONTIC JOURNAL 2017; 12:449-453. [PMID: 29225640 PMCID: PMC5722109 DOI: 10.22037/iej.v12i4.16224] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction The aim of this prospective, randomized, double-blind study was to investigate the effect of articaine combined with ketamine on the success rate of inferior alveolar nerve block (IANB) in posterior mandible teeth with symptomatic irreversible pulpitis. Methods and Materials Forty two adult patients with diagnosis of symptomatic irreversible pulpitis of a mandibular posterior tooth were selected. The patients received two cartridges of either containing 3.2 mL 4% articaine with epinephrine 1:200000 and 0.4 mL 50 mg/mL ketamine hydrochloride (A-ketamine group) or 3.2 mL 4% articaine with epinephrine 1:200000 and 0.4 mL normal saline (A-saline group) using conventional IANB injections. Access cavity preparation started 15 min after injection. Lip numbness was required for all the patients. Success was considered as no or mild pain on the basis of Heft-Parker visual analog scale recordings upon access cavity preparation or initial instrumentation. Data were analyzed by independent student t, Mann-Whitney and Chi-square tests. Results The success rates were 55% and 42.9% for A-ketamine and A-saline group, respectively, with no significant differences between the two groups (P=0.437). Conclusion Adding 0.4 mL 50 mg/mL ketamine hydrochloride to the articaine local anesthetic did not increase the efficacy of IANB for posterior mandibular teeth with symptomatic irreversible pulpitis.
Collapse
Affiliation(s)
- Vahid Sakhaeimanesh
- Department of Endodontics, Dental Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saber Khazaei
- Department of Endodontics, Dental Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Naser Kaviani
- Department of Oral and Maxillofacial Surgery, Dental Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoud Saatchi
- Department of Endodontics, Dental Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Shafiei
- Department of Endodontics, Dental Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abbasali Khademi
- Department of Endodontics, Dental Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
17
|
Analgesia (mis)usage on a dental emergency service: a patient survey. Clin Oral Investig 2017; 22:1297-1302. [DOI: 10.1007/s00784-017-2228-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 09/27/2017] [Indexed: 11/26/2022]
|
18
|
Taggar T, Wu D, Khan AA. A Randomized Clinical Trial Comparing 2 Ibuprofen Formulations in Patients with Acute Odontogenic Pain. J Endod 2017; 43:674-678. [PMID: 28320537 DOI: 10.1016/j.joen.2016.12.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/30/2016] [Accepted: 12/11/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Ibuprofen sodium dihydrate, a new formulation of ibuprofen, was introduced with the claim of faster onset of analgesia. Most of the data on this new ibuprofen formulation are drawn from studies using the oral surgery model. Because this model differs significantly from the endodontic pain model, we conducted a study comparing ibuprofen sodium dihydrate with conventional ibuprofen acid in endodontic pain patients. METHODS This randomized, double-masked study recruited subjects experiencing moderate to severe pain from a tooth diagnosed with symptomatic irreversible pulpitis and symptomatic apical periodontitis (n = 41). Subjects were randomized to receive 400 mg ibuprofen acid (Advil; Pfizer, Madison, NJ) or an equivalent dose of 512 mg ibuprofen sodium dihydrate (Advil Sodium, Pfizer). The outcome measures were time to onset of 50% pain relief recorded using a stopwatch, reduction in spontaneous pain experienced on a 100-mm visual analog scale, and change in mechanical allodynia measured using a bite force transducer. The last 2 measures were obtained before and 60 minutes after administration of the drug. RESULTS The median time to onset of 50% pain relief after administration of ibuprofen sodium dihydrate was significantly faster compared with ibuprofen acid (26.5 vs 44 minutes, P = .08). Ibuprofen sodium dihydrate provided a greater reduction in spontaneous pain (50.8% vs 33.3%, P < .05) and mechanical allodynia (15% vs 9%, P > .05). CONCLUSIONS In endodontic pain patients, a single dose of ibuprofen sodium dihydrate provides faster onset of pain relief and a greater reduction in spontaneous and evoked pain compared with ibuprofen acid.
Collapse
Affiliation(s)
| | - Di Wu
- Department of Periodontology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Asma A Khan
- Department of Endodontics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| |
Collapse
|
19
|
Kishnani S, Saha SG, Bhardwaj A, Dubey S, Saha M, Kala S, Jain S, Narwani S. Unmasking the Effect of Analgesics on Endodontic Diagnosis Using a Novel Bite Force Sensor Device: A Prospective, Randomized Clinical Trial. J Clin Diagn Res 2016; 10:ZC38-ZC42. [PMID: 27891455 DOI: 10.7860/jcdr/2016/21116.8640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 09/16/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION A definitive diagnosis is of primary importance before initiating any endodontic treatment; yet, there are occasions when the dental professional is unable to accurately reproduce the patient's chief complaint, as it can pose a dilemma and may require consideration of multiple variables in order to reach an accurate diagnosis. So to overcome this problem, a methodical approach in providing endodontic treatment should be implemented which includes diagnosis, definitive dental treatment and adjunctive drug therapy, known as the "3D" strategy. AIM The purpose of this study was to evaluate the possible "masking" effect of these analgesics on endodontic diagnosis using a novel bite force sensor device. MATERIALS AND METHODS A total of 90 patients with endodontic pain were selected and they were given either a placebo or 400 mg ibuprofen (brufen) or 50mg diclofenac sodium (voveron). Both patients and operators were completely blinded to the drugs administered. Bite force tolerance values were noted before and one hour after administration of medication using the self designed bite force sensor. RESULTS The pre- and post-bite force tolerance values were tabulated for both contralateral and affected tooth. For the affected tooth, there was statistically significant difference between pre- and post-bite force tolerance values in Group I (i.e., ibuprofen) and Group II (i.e., diclofenac sodium) (p<0.05) with no significant difference observed in Group III (placebo). CONCLUSION The easily available over the counter self administered analgesics in addition to providing symptomatic relief to patients suffering from symptomatic apical periodontitis may also cloud the definitive diagnosis of the clinician, thus jeopardising the treatment plan. The self designed bite force sensor was effective in arriving at a definitive diagnosis in teeth with chronic irreversible pulpitis with symptomatic apical periodontitis, where the allodynia has been camouflaged by the use of analgesics like ibuprofen and diclofenac sodium.
Collapse
Affiliation(s)
- Sushil Kishnani
- Postgradutae Student, Department of Conservative Dentistry and Endodontics, College of Dental Science and Hospital , Indore, Madhya Pradesh, India
| | - Suparna Ganguly Saha
- Professor and Head of Department, Department of Conservative Dentistry and Endodontics, College of Dental Science and Hospital , Indore, Madhya Pradesh, India
| | - Anuj Bhardwaj
- Reader, Department of Conservative Dentistry and Endodontics, College of Dental Science and Hospital , Indore, Madhya Pradesh, India
| | - Sandeep Dubey
- Senior Lecturer, Department of Conservative Dentistry and Endodontics, College of Dental Science and Hospital , Indore, Madhya Pradesh, India
| | - Mainak Saha
- Professor and Head of Department, Department of Prosthodontics, College of Dental Science and Hospital , Indore, Madhya Pradesh, India
| | - Shubham Kala
- Senior Lecturer, Department of Conservative Dentistry and Endodontics, College of Dental Science and Hospital , Indore, Madhya Pradesh, India
| | - Sohini Jain
- Postgraduate Student, Department of Conservative Dentistry and Endodontics, College of Dental Science and Hospital , Indore, Madhya Pradesh, India
| | - Shweta Narwani
- Postgraduate Student, Department of Prosthodontics, People's Dental Academy , Bhopal, Madhya Pradesh, India
| |
Collapse
|
20
|
Agnihotry A, Fedorowicz Z, van Zuuren EJ, Farman AG, Al-Langawi JH. Antibiotic use for irreversible pulpitis. Cochrane Database Syst Rev 2016; 2:CD004969. [PMID: 26886473 DOI: 10.1002/14651858.cd004969.pub4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
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 number of dentists continue to prescribe antibiotics to stop the pain of irreversible pulpitis.This review updates the previous version published in 2013. OBJECTIVES To assess the effects of systemic antibiotics for irreversible pulpitis. SEARCH METHODS We searched the Cochrane Oral Health Group's Trials Register (to 27 January 2016); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2015, Issue 12); MEDLINE via Ovid (1946 to 27 January 2016); EMBASE via Ovid (1980 to 27 January 2016), ClinicalTrials.gov (to 27 January 2016) and the WHO International Clinical Trials Registry Platform (to 27 January 2016). There were no language restrictions in the searches of the electronic databases. SELECTION CRITERIA Randomised controlled trials 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 Two review authors screened studies and extracted data independently. We assessed the quality of the evidence of included studies using GRADEpro software. Pooling of data was not possible and a descriptive summary is presented. MAIN RESULTS One trial assessed at low risk of bias, involving 40 participants was included in this update of the review. The quality of the body of evidence was rated low for the different outcomes. There was a close parallel distribution of the pain ratings in both the intervention and placebo groups over the seven-day study period. There was insufficient evidence to claim or refute a benefit for penicillin for pain intensity. There was no significant difference in the mean total number of ibuprofen tablets over the study period: 9.2 (standard deviation (SD) 6.02) in the penicillin group versus 9.6 (SD 6.34) in the placebo group; mean difference -0.40 (95% confidence interval (CI) -4.23 to 3.43; P value = 0.84). This applied equally for the mean total number of Tylenol tablets: 6.9 (SD 6.87) used in the penicillin group versus 4.45 (SD 4.82) in the placebo group; mean difference 2.45 (95% CI -1.23 to 6.13; P value = 0.19). Our secondary outcome on reporting of adverse events was not addressed in this study. AUTHORS' CONCLUSIONS This systematic review which was based on one low powered small sample trial assessed as at low risk of bias, illustrates that there is insufficient evidence to determine whether antibiotics reduce pain or not compared to not having antibiotics. The results of this review confirm the necessity for further larger sample and methodologically sound trials that can provide additional evidence as to whether antibiotics, prescribed in the preoperative phase, can affect treatment outcomes for irreversible pulpitis.
Collapse
Affiliation(s)
- Anirudha Agnihotry
- Section of Restorative Dentistry, UCLA School of Dentistry, 10833 Le Conte Avenue, Los Angeles, USA, CA 90095-1668
| | | | | | | | | |
Collapse
|
21
|
|
22
|
Effect of Ibuprofen on Masking Endodontic Diagnosis. J Endod 2014; 40:1058-62. [DOI: 10.1016/j.joen.2014.05.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 04/14/2014] [Accepted: 05/09/2014] [Indexed: 11/17/2022]
|
23
|
Fedorowicz Z, van Zuuren EJ, Farman AG, Agnihotry A, Al-Langawi JH. Antibiotic use for irreversible pulpitis. Cochrane Database Syst Rev 2013:CD004969. [PMID: 24353116 DOI: 10.1002/14651858.cd004969.pub3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
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 number of dentists continue to prescribe antibiotics to stop the pain of irreversible pulpitis. OBJECTIVES To assess the effects of systemic antibiotics for irreversible pulpitis. SEARCH METHODS We searched the Cochrane Oral Health Group's Trials Register (to 5 September 2013); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 9); MEDLINE via OVID (1946 to 5 September 2013); EMBASE via OVID (1980 to 5 September 2013) and the US National Institutes of Health Trials Register (http://clinicaltrials.gov). There were no language restrictions in the searches of the electronic databases. SELECTION CRITERIA Randomised controlled trials 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 Two review authors screened studies and extracted data independently. We assessed the quality of the evidence of included studies using GRADEPro software. Pooling of data was not possible and a descriptive summary is presented. MAIN RESULTS One trial assessed at low risk of bias, involving 40 participants was included in this update of the review. The quality of the body of evidence was rated low for the different outcomes. There was a close parallel distribution of the pain ratings in both the intervention and placebo groups over the seven-day study period. There was insufficient evidence to claim or refute a benefit for penicillin for pain intensity. There was no significant difference in the mean total number of ibuprofen tablets over the study period: 9.2 (standard deviation (SD) 6.02) in the penicillin group versus 9.6 (SD 6.34) in the placebo group; mean difference -0.40 (95% confidence interval (CI) -4.23 to 3.43; P value = 0.84). This applied equally for the mean total number of Tylenol tablets: 6.9 (SD 6.87) used in the penicillin group versus 4.45 (SD 4.82) in the placebo group; mean difference 2.45 (95% CI -1.23 to 6.13; P value = 0.19). Our secondary outcome on reporting of adverse events was not addressed in this study. AUTHORS' CONCLUSIONS This systematic review which was based on one low powered small sample trial assessed as a low risk of bias, illustrates that there is insufficient evidence to determine whether antibiotics reduce pain or not compared to not having antibiotics. The results of this review confirm the necessity for further larger sample and methodologically sound trials that can provide additional evidence as to whether antibiotics, prescribed in the preoperative phase, can affect treatment outcomes for irreversible pulpitis.
Collapse
Affiliation(s)
- Zbys Fedorowicz
- Bahrain Branch, The Cochrane Collaboration, Box 25438, Awali, Bahrain
| | | | | | | | | |
Collapse
|
24
|
Effect of Nitrous Oxide on the Efficacy of the Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis. J Endod 2012; 38:565-9. [DOI: 10.1016/j.joen.2012.02.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 02/07/2012] [Accepted: 02/09/2012] [Indexed: 11/22/2022]
|
25
|
Anesthetic efficacy of combinations of 0.5 mol/L mannitol and lidocaine with epinephrine for inferior alveolar nerve blocks in patients with symptomatic irreversible pulpitis. J Endod 2012; 38:598-603. [PMID: 22515886 DOI: 10.1016/j.joen.2012.02.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 02/08/2012] [Accepted: 02/09/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The purpose of these 2 prospective, randomized, single-blind studies was to determine the anesthetic efficacy of lidocaine with epinephrine compared with a combination lidocaine with epinephrine plus 0.5 mol/L mannitol for inferior alveolar nerve (IAN) blocks in patients experiencing symptomatic irreversible pulpitis. METHODS In study one, 55 emergency patients randomly received IAN blocks by using a 3.18-mL formulation containing 63.6 mg of lidocaine with 31.8 μg epinephrine or a 5-mL formulation containing 63.6 mg of lidocaine with 31.8 μg epinephrine (3.18 mL) plus 1.82 mL of 0.5 mol/L mannitol. In study two, 51 emergency patients randomly received IAN blocks by using a 1.9-mL formulation containing 76.4 mg of lidocaine with 36 μg epinephrine or a 3-mL formulation containing 76.4 mg of lidocaine with 36 μg epinephrine (1.9 mL) plus 1.1 mL of 0.5 mol/L mannitol. Endodontic access was begun 15 minutes after the IAN block, and all patients had profound lip numbness. Success was defined as no or mild pain (visual analogue scale recordings) on endodontic access or instrumentation. RESULTS The 1.9 mL of lidocaine (76.4 mg) with epinephrine plus 0.5 mol/L mannitol had a significantly (P = .04) better success rate of 39% when compared with the lidocaine formulation without mannitol (13% success rate). CONCLUSIONS For mandibular posterior teeth in patients with symptomatic irreversible pulpitis, the addition of 0.5 mol/L mannitol to 1.9 mL of lidocaine (76.4 mg) with epinephrine resulted in a statistically higher success rate. However, the combination lidocaine/mannitol formulation would not result in predictable pulpal anesthesia.
Collapse
|
26
|
Drum M, Reader A, Beck M. Long buccal nerve block injection pain in patients with irreversible pulpitis. ACTA ACUST UNITED AC 2011; 112:e51-4. [DOI: 10.1016/j.tripleo.2011.01.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 01/21/2011] [Accepted: 01/22/2011] [Indexed: 11/27/2022]
|
27
|
Barasch A, Safford MM, McNeal SF, Robinson M, Grant VS, Gilbert GH. Patterns of postoperative pain medication prescribing after invasive dental procedures. SPECIAL CARE IN DENTISTRY 2011; 31:53-7. [PMID: 21371065 DOI: 10.1111/j.1754-4505.2011.00181.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We investigated disparities in the prescription of analgesics following dental procedures that were expected to cause acute postoperative pain. Patients over the age of 19 years who had been treated by surgical and/or endodontic dental procedures were included in this study. We reviewed 900 consecutive charts and abstracted data on procedures, patients, and providers. We used chi-square and logistic regression models for analyses. There were 485 White subjects, 357 African American subjects included in this review; 81% of the African American and 78% of White patients received a postoperative narcotic prescription (p = .56). In multivariate regression models, patients over age 45 (p = .003), those with insurance that covered medication and those with preexisting pain (p = .004) were more likely to receive narcotic analgesics. Students prescribed more narcotics than residents (p = .001). No differences were found by race in prescribing analgesics.
Collapse
Affiliation(s)
- Andrei Barasch
- Department of General Dental Sciences, University of Alabama at Birmingham School of Dentistry, Birmingham, Alabama, USA.
| | | | | | | | | | | |
Collapse
|
28
|
Asgary S, Eghbal MJ. The effect of pulpotomy using a Calcium-Enriched Mixture cement versus one-visit root canal therapy on postoperative pain relief in irreversible pulpitis: a randomized clinical trial. Odontology 2010; 98:126-33. [DOI: 10.1007/s10266-010-0127-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Accepted: 02/24/2010] [Indexed: 11/29/2022]
|
29
|
Lindemann M, Reader A, Nusstein J, Drum M, Beck M. Effect of Sublingual Triazolam on the Success of Inferior Alveolar Nerve Block in Patients with Irreversible Pulpitis. J Endod 2008; 34:1167-70. [DOI: 10.1016/j.joen.2008.07.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Revised: 07/15/2008] [Accepted: 07/16/2008] [Indexed: 02/06/2023]
|
30
|
Iqbal M, Kim S, Yoon F. An Investigation Into Differential Diagnosis of Pulp and Periapical Pain: A PennEndo Database Study. J Endod 2007; 33:548-51. [PMID: 17437869 DOI: 10.1016/j.joen.2007.01.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Revised: 01/02/2007] [Accepted: 01/09/2007] [Indexed: 11/25/2022]
Abstract
Nine hundred fifty-one emergency and 997 nonemergency patients seeking endodontic treatment were the basis of this study. Variables of interest were 10 pain descriptors, percussion and palpation tests, causative factors, and paired pulpal and periapical diagnoses. A higher number of patients suffering from symptomatic pulpal conditions sought emergency care. Odds of caries being a causative factor were high in symptomatic pulps compared with asymptomatic pulpal and periapical conditions. Higher odds ratios were obtained for sharp pain in symptomatic pulps versus symptomatic periapical conditions. Conversely, odds ratios for dull pain were higher in symptomatic periapical conditions compared with asymptomatic periapical conditions. Percussion and palpation tests were significant in differentially diagnosing between pulpal and periapical conditions. In conclusion, caries was associated with painful pulpitis. The results confirm the differential diagnostic power of sharp and dull pain and percussion and palpation tests. Several symptoms previously believed to have differential diagnostic power were found insignificant.
Collapse
Affiliation(s)
- Mian Iqbal
- Postdoctoral Endodontic Program, Department of Endodontics, University of Pennsylvania, School of Dental Medicine, Robert Schattner Center, Philadelphia, PA 19104-6030, USA.
| | | | | |
Collapse
|
31
|
Porter RWJ, Poyser NJ, Briggs PF. A life threatening event from poorly managed dental pain – a case report. Br Dent J 2007; 202:203-6. [PMID: 17322844 DOI: 10.1038/bdj.2007.144] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2006] [Indexed: 11/08/2022]
Abstract
The history of a patient who suffered encephalopathy and coma is presented. A 25-year-old female consumed large quantities of cold water over several weeks, to control long-term dental pain. This eventually led to dilution hyponatraemia, followed by a seizure and encephalopathy. The patient made a good recovery after spending three days in neurological intensive care. Conventional endodontic therapy immediately resolved her symptoms following recovery from this life-threatening episode. Prior to her admission the patient had experienced difficulties in gaining access to effective emergency dental care. Her problems could have been avoided if appropriate management had been provided sooner. The dental profession should be aware of the potential life-threatening risk when continued water consumption is used to control the long-term pulpitic pain. Primary care agencies should ensure that information on local emergency dental services is well disseminated to the population. Dental surgeons should be able to manage acute dental pain.
Collapse
Affiliation(s)
- R W J Porter
- Guys, Kings and St. Thomas' Dental Institute and St. George's Hospital, Tooting, London, UK.
| | | | | |
Collapse
|
32
|
Bigby J, Reader A, Nusstein J, Beck M. Anesthetic Efficacy of Lidocaine/Meperidine for Inferior Alveolar Nerve Blocks in Patients with Irreversible Pulpitis. J Endod 2007; 33:7-10. [PMID: 17185118 DOI: 10.1016/j.joen.2006.09.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2006] [Revised: 09/03/2006] [Accepted: 09/07/2006] [Indexed: 11/30/2022]
Abstract
The purpose of this prospective, randomized, single-blind study was to compare the anesthetic efficacy of lidocaine with epinephrine to lidocaine plus meperidine with epinephrine for inferior alveolar nerve blocks (IAN) in patients with mandibular posterior teeth experiencing irreversible pulpitis. Forty-eight emergency patients diagnosed with irreversible pulpitis of a mandibular posterior tooth randomly received, in a single-blind manner, 36 mg of lidocaine with 18 mug epinephrine or 36 mg of lidocaine with 18 mug of epinephrine plus 36 mg meperidine with 18 mug epinephrine, using a conventional inferior alveolar nerve block. Endodontic access was begun 15 minutes after solution deposition, and all patients were required to have profound lip numbness. Success was defined as no or mild pain (visual analog scale recordings) upon endodontic access or initial instrumentation. The success rate for the inferior alveolar nerve block using the lidocaine solution was 26%, and for the lidocaine/meperidine solution, the success rate was 12%. There was no significant difference (p = 0.28) between the two solutions. In conclusion, for mandibular posterior teeth with irreversible pulpitis, the addition of 36 mg of meperidine to a lidocaine solution administered in a conventional IAN block did not improve the success rate over a standard lidocaine solution.
Collapse
Affiliation(s)
- Jason Bigby
- Department of Endodontics, College of Dentistry, The Ohio State University, Columbus, Ohio, USA
| | | | | | | |
Collapse
|
33
|
Cheng Y, Cheung GSP, Bian Z, Peng B. Incidence and factors associated with endodontic inter-appointment emergency in a dental teaching hospital in China. J Dent 2006; 34:516-21. [PMID: 16414172 DOI: 10.1016/j.jdent.2005.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2005] [Revised: 12/02/2005] [Accepted: 12/06/2005] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To assess the incidence of endodontic inter-appointment emergency (EIE) in a dental teaching hospital in China, and to correlate its occurrence with preoperative and treatment parameters. METHODS Three thousand six hundred and ninety six cases were collected at root canal treatment appointments on demographics, presenting symptoms, treatment procedures and periradicular status. The operators consisted of faculty, undergraduate students and advanced trainees. Root canals were conventionally instrumented and then medicated. No systemic medication was prescribed. In cases EIE developed between appointments, an emergency visit was arranged and active treatment was carried out. The data of EIE cases were statistically analyzed using the chi-square test and a multiple logistic regression model. RESULTS The overall incidence of EIE was 5%, which rate was 5.5% in females and 4.3% in males. Analyses of the potential factors revealed that patient age, tooth location, preoperative percussion pain and pulp status were the most important independent variables. CONCLUSION EIE was significantly associated with some host factors (patient age, tooth location) and presenting factors (preoperative percussion pain, pulp status).
Collapse
Affiliation(s)
- Yue Cheng
- Department of Operative Dentistry and Endodontics, School of Stomatology, Wuhan University, China
| | | | | | | |
Collapse
|
34
|
Abstract
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.
Collapse
Affiliation(s)
- J V Keenan
- U.S. Naval Health Clinics United Kingdom, PSC 821, Box 51, FPO AE 09421-0051, UK.
| | | | | | | |
Collapse
|
35
|
Claffey E, Reader A, Nusstein J, Beck M, Weaver J. Anesthetic Efficacy of Articaine for Inferior Alveolar Nerve Blocks in Patients with Irreversible Pulpitis. J Endod 2004; 30:568-71. [PMID: 15273637 DOI: 10.1097/01.don.0000125317.21892.8f] [Citation(s) in RCA: 184] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this prospective, randomized, double-blind study was to compare the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine to 2% lidocaine with 1:100,000 epinephrine for inferior alveolar nerve blocks in patients experiencing irreversible pulpitis in mandibular posterior teeth. Seventy-two emergency patients diagnosed with irreversible pulpitis of a mandibular posterior tooth randomly received, in a double-blind manner, 2.2 ml of 4% articaine with 1:100,000 epinephrine or 2.2 ml of 2% lidocaine with 1:100,000 epinephrine using a conventional inferior alveolar nerve block. Endodontic access was begun 15 min after solution deposition, and all patients were required to have profound lip numbness. Success was defined as none or mild pain (Visual Analogue Scale recordings) on endodontic access or initial instrumentation. The success rate for the inferior alveolar nerve block using articaine was 24% and for the lidocaine solution success was 23%. There was no significant difference (p = 0.89) between the articaine and lidocaine solutions. Neither solution resulted in an acceptable rate of anesthetic success in patients with irreversible pulpitis.
Collapse
Affiliation(s)
- Elizabeth Claffey
- Department of Oral Surgery, Oral Pathology, and Anesthesiology, The Ohio State University, Columbus, OH 43218, USA
| | | | | | | | | |
Collapse
|