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de Souza PRJ, Ardestani SS, Costa VASM, Alcalde MP, Hungaro Duarte MA, Vivan RR, Conti PCR, Costa YM, Bonjardim LR. Referred pain is associated with greater odontogenic spontaneous pain and a heightened pain sensitivity in patients with symptomatic irreversible pulpitis. J Oral Rehabil 2024. [PMID: 38797958 DOI: 10.1111/joor.13725] [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: 01/05/2023] [Revised: 03/22/2024] [Accepted: 04/26/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Symptomatic irreversible pulpitis often results in heightened reactions to thermal stimuli such as pain evoked by a cold stimulus, and spontaneous odontogenic pain (unprovoked pain). OBJECTIVE This study primarily compared the clinical manifestations of odontogenic spontaneous pain and pain provoked by cold stimulus specifically focusing on their sensory discriminative characteristics (intensity, duration and quality) between symptomatic irreversible pulpitis patients with and without referred pain. METHODS Twenty-three patients with symptomatic irreversible pulpitis with referred pain and 12 patients without referred pain were included in this cross-sectional study. The following outcomes were assessed: odontogenic spontaneous pain and its descriptors; pain evoked by cold stimulus and qualitative sensory testing before and after local anaesthesia; referred pain location; use of analgesic medication; complementary anaesthesia efficacy. T-test, chi-squared and McNemar tests were applied to the data (p < .50). RESULTS Patients with referred pain presented a greater odontogenic pain intensity (p < .05) when considered the average of the last 24 h. These patients also showed higher pain rating and pain descriptors (p < .05). Intensity and duration of the pain evoked by cold stimulus in the non-affected contralateral tooth at baseline were higher for patients with referred pain (p < .05). CONCLUSION Symptomatic irreversible pulpitis patients with referred pain present greater odontogenic spontaneous pain and a heightened pain sensitivity. Therefore, patients with referred pain seem more complex from a pain severity perspective, supporting the clinical utility of discriminating symptomatic irreversible pulpitis with and without referred pain.
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Affiliation(s)
- Paulo Roberto Jara de Souza
- Department of Dentistry, Endodontics, and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Soraya Salmanzadeh Ardestani
- Department of Periodontology and Prosthodontics, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | | | - Murilo Priori Alcalde
- Department of Dentistry, Endodontics, and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Marco Antônio Hungaro Duarte
- Department of Dentistry, Endodontics, and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Rodrigo Ricci Vivan
- Department of Dentistry, Endodontics, and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Paulo César Rodrigues Conti
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Yuri Martins Costa
- Department of Biosciences, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Leonardo Rigoldi Bonjardim
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
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Beecroft EV, Edwards D, Allison JR. Other Secondary Headaches: Odontogenic Pain and Other Painful Orofacial Conditions. Neurol Clin 2024; 42:615-632. [PMID: 38575270 DOI: 10.1016/j.ncl.2023.12.013] [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: 04/06/2024]
Abstract
This article discusses extremely common odontogenic pain conditions, which may occasionally present to the neurology clinic mimicking headache, and other uncommon orofacial pain conditions, which may do the same. Typical presentations, investigative strategies, and management are discussed, as well as highlighting key diagnostic criteria and the importance of involving oral or dental specialists where diagnostic uncertainty exists.
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Affiliation(s)
- Emma V Beecroft
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom; Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom.
| | - David Edwards
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom; Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - James R Allison
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom; Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
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3
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Edwards D, Rasaiah S, Kirkevang LL, Vaeth M, Stone SJ, Obara I, Durham J, Whitworth J. The use of medicaments in the management of symptomatic irreversible pulpitis: A community-based cohort study. Int Endod J 2024; 57:416-430. [PMID: 38214015 DOI: 10.1111/iej.14020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/15/2023] [Accepted: 01/02/2024] [Indexed: 01/13/2024]
Abstract
AIM To investigate patient outcomes from either pulpotomy or pulpectomy for the management of symptomatic irreversible pulpitis, with and without application of antibiotic/corticosteroid pastes in urgent primary dental care settings in the United Kingdom. METHODOLOGY All patients receiving intervention for symptomatic irreversible pulpitis in three different primary care settings were invited to participate. Pre-operatively, data regarding patients' numerical ratings scale (NRS), pain score (0-10), analgesic use, oral-health impact profile-14 (OHIP-14) and need for time away from work were collected. For 7 days post-operatively, participants recorded their NRS pain score, global rating of change score, medication use and their ability to work. Analysis used a mixed-effects model with post hoc Tukey's multiple comparisons test for continuous data and chi-squared or Fisher's exact test for categorical data. To test the effect of the corticosteroid/antibiotic paste, pulpectomy and pulpotomy groups were combined following Mantel-Haenszel stratified analysis or a weighted average of the difference between pulpotomy and pulpectomy with and without the use of corticosteroid/antibiotic paste. A binary composite score was constructed using pre- and post-operative data, whereby overall treatment success was defined as: (i) patients did not return for treatment due to pain by day seven; (ii) at day three, there was a 33% (or 2-points) reduction in NRS pain score; (iii) there was a change score of +3 in global rating; (iv) the patient was no longer using analgesia and able to return to work. RESULTS Eighty-five participants were recruited, with 83 completing follow up. Overall treatment success was 57%, with 25% of participants returning for more treatment due to inadequate pain relief. Overall treatment success did not differ between the two groups (p = .645), although patients self-reported greater improvement with an antibiotic/corticosteroid dressing for global rating of change (p = .015). CONCLUSIONS This study identified limited evidence of improved outcomes using antibiotic/corticosteroid dressings in the management of symptomatic irreversible pulpitis in the emergency setting. Further clinical research is needed to understand if these medications are beneficial in affording pain relief, above that of simple excision of irreversibly inflamed pulp tissue.
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Affiliation(s)
- David Edwards
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Sabrina Rasaiah
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Michael Vaeth
- Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Simon J Stone
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Ilona Obara
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK
| | - Justin Durham
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - John Whitworth
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
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Abdelwahab DH, Kabil NS, Badran AS, Darwish D, Abd El Geleel OM. One-year radiographic and clinical performance of bioactive materials in primary molar pulpotomy: A randomized controlled trial. J Dent 2024; 143:104864. [PMID: 38281619 DOI: 10.1016/j.jdent.2024.104864] [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] [Received: 12/16/2023] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 01/30/2024] Open
Abstract
OBJECTIVES Mineral Trioxide Aggregate (MTA) is considered the gold standard material for pulpotomy procedures. However, some drawbacks such as poor handling and long setting time are challenging when it is used as pulpotomy dressing in primary molars in children. Hence, the purpose of this study was to compare the radiographic and clinical performance of a premixed, fast setting bioceramic root repair material (BC RRM-F) with MTA in vital pulpotomy procedures of primary molars, with or without the added seal of a stainless steel crown (SSC). METHODS In this double blinded, four-arm, parallel group randomized contolled trial (RCT), 64 primary molars were randomly allocated to one of the four treatment groups: MTA (PDTM MTA WHITE)+SSC, MTA+GI (bulk fill glass ionomer with glass hybrid technology GC EQUIA Forte® HT), BC RRM-F+GI and BC RRM-F+SCC. All molars were evaluated clinically and radiographically according to the modified Zurn and Seale criteria at 1, 3, 6, and 12 months follow up. Multivariate cox regression models and Kaplan-Meier curves were used for survival analysis. RESULTS There was no statistically significant difference between the success of both pulp capping materials used. Overall survival analysis showed that using GI instead of SCC as a final restorative material was significantly associated with increased risk of failure. CONCLUSIONS TotalFill® BC RRM™ Fast Set Putty can be used as an alternative to MTA in primary molar pulpotomy. Regardless of the pulp capping material, one year survival of pulpotomized primary molars restored with SSC is higher compared to those restored with GC EQUIA Forte® HT. CLINICAL SIGNIFICANCE Clinicians' preference and cost effectiveness may justify the use of either material in primary molar pulpotomy. Parents insisting on tooth-colored restorations for their children's pulpotomized teeth cannot be told that the expectation for success is the same as those restored with SSC, even if calcium silicate-based pulp capping materials are used.
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Affiliation(s)
- Dina Hisham Abdelwahab
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Ain Shams University, Egypt.
| | - Noha Samir Kabil
- Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Ain Shams University, Egypt
| | - Amira Saad Badran
- Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Ain Shams University, Egypt
| | - Dina Darwish
- Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Ain Shams University, Egypt
| | - Ola Mohamed Abd El Geleel
- Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Ain Shams University, Egypt
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Comparison of bromazepam and ibuprofen influence on tooth pulp-evoked potentials in humans. SRP ARK CELOK LEK 2022. [DOI: 10.2298/sarh220131047v] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction/Objective Somatosensory evoked potentials are a
neurophysiological tool for testing the effects of drugs in humans and
animals. The aim of this study was to estimate the way that bromazepam and
ibuprofen had on tooth pulp-evoked potentials (TPEPs) after non-painful
stimuli, as well as to detect possible differences in this activity.
Methods Sixty young healthy subjects were included in the study. They were
arranged into three groups: ibuprofen, bromazepam and placebo. To record
TPEPs response, dental pulp was electrically stimulated through intact
enamel with non-painful stimuli. For stimulation and registration, we used
Xltek Protektor 32 system, software EPWorks, version 5.0. The experiment
consisted of two testing sessions. Five recordings were performed in each
session. The first test session was before, and the second was 45 minutes
after administration of a single dose of the ibuprofen (400 mg), bromazepam
(1.5 mg) or placebo. Results The results of the present study exhibit that
both ibuprofen and bromazepam significantly increased all the latencies;
ibuprofen decreased amplitudes of all the waves except the first one (p <
0.05), and bromazepam decreased amplitudes of all the waves except the first
one (p < 0.05); placebo did not modified TPEPs waves (p > 0.05).
Additionally, there were no significant differences in influence on TPEPs
between bromazepam and ibuprofen (p > 0.05). Conclusion Our study showed
that both bromazepam and ibuprofen had the same influence on TPEPs after
non-painful stimuli. That indicates that anxiolytic dose of bromazepam
affects neurotransmission in the same manner as non-opioid analgesics
ibuprofen.
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Edwards D, Bailey O, Stone S, Duncan H. The management of deep caries in UK primary care: A nationwide questionnaire-based study. Int Endod J 2021; 54:1804-1818. [PMID: 34089184 DOI: 10.1111/iej.13585] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 11/30/2022]
Abstract
AIM To investigate current approaches and attitudes towards the management of deep caries in primary dental care within the United Kingdom (UK). METHODOLOGY Open distribution of an electronic questionnaire survey was undertaken to primary care dental professionals working in publicly funded National Health Service [NHS], privately funded, military and community dental services. Demographic variables investigated included the following: place of qualification, method of remuneration, level of restorative training, materials available, years qualified, appointment length and clinician type. Management variables focussed on case-based scenarios. Univariate analyses of responses to questions were undertaken using χ2 tests with sequential Bonferroni correction. Variables with a statistical relationship of p ≤ .2 were selected for binary logistic regression modelling. RESULTS A total of 657 responses were received. Practitioners with formal postgraduate qualifications (PGQ) were more likely (OR, 95%CI) to undertake further tests to aid diagnosis including: gaining a patient history (1.80, 1.01-3.20), periapical radiography (1.43, 1.01-2.03), cold pulp testing (2.079, 1.46-2.97) and electric pulp testing (1.65, 1.02-2.65). Rubber dam was infrequently used for deep caries management (29.2%). Non-NHS practitioners were much more likely to use rubber dam (3.40, 2.15-5.37), as were those that had completed PGQ (2.24, 1.48-3.38). Non-selective caries removal was used in deep caries by 41.4% of practitioners. Indirect pulp caps were carried out by 56.7% of practitioners. NHS practitioners were more likely to place calcium hydroxide (3.74, 1.97-7.15), whilst non-NHS practitioners were more likely to place calcium silicate cements (CSCs) (3.303, 1.71-6.38) as were non-UK graduates (5.63, 2.47-12.86) and those with PGQ (2.12, 1.17-3.87). CONCLUSIONS This UK survey highlights significant variation in the management of deep caries. There is lack of consensus regarding the use of a standard systematic approach to diagnosing disease, with a reliance on history and tests with poor specificity. Non-selective caries removal for managing deep carious lesions remains common, with low rubber dam compliance underlining a lack of asepsis. Notably, a significant number of practitioners placed indirect pulp caps, but CSCs and GIC were not commonly used. At present, although clear guidelines are available this is not translating into consistent management approaches in practice, suggesting that better dissemination of current treatments is essential to undergraduate and postgraduate groups.
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Affiliation(s)
- David Edwards
- Restorative Department, Newcastle Dental Hospital, Newcastle upon Tyne, UK
| | - Oliver Bailey
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Simon Stone
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Hal Duncan
- Division of Restorative Dentistry and Periodontology, Trinity College Dublin, Dublin Dental University Hospital, Dublin, Ireland
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