Dental Pain: Dentine Sensitivity, Hypersensitivity and Cracked Tooth Syndrome

The impact of animated video cartoons as a distraction technique on anticipatory anxiety levels among children during class I GIC restoration procedures

PURPOSE

Investigating the effect of visual distraction using animated video cartoons (AVCs) on anxiety of children during class I class I glass-ionomer cement (GIC) restoration procedures.

PATIENTS AND METHODS

This randomized clinical trial, 42 children between the ages of 5-6 years were enrolled. These participants were divided into two groups: Group 1, consisting of 21 individuals (AVCs), who were exposed to a cartoon as a visual distraction tool, and Group 2, a control group with 21 participants who did not receive any form of distraction during their first visit. Both groups underwent class I GIC restoration procedures that were conducted in a consistent manner. To evaluate the anxiety levels of the children, measurements of their pulse rate (PR) were taken at the beginning and end of the treatment. Additionally, patient behavior was assessed using the Frankl behavior rating scale (FBRS) as well as validated self-reported dental anxiety scale, the Visual Analog Scale - Anxiety (VAS-A) score.

RESULTS

In the control group, postoperative PR increased significantly, while the AVC group experienced a decrease compared to their preoperative PR levels. Additionally, audio-visual distraction had a notable impact on FBRS scores compared to the standard approach. Similarly, the VAS-A score displayed a significant reduction when patients received audio-visual distraction compared to the control condition. Subgroup analysis by gender showed that girls tended to be more responsive to AVCs than boys when evaluated by PR and FBRS, but such findings were not observed using VAS-A. Patients with deeper caries had higher VAS-A scores than those with shallower ones. Despite the caries depth, those who received AVC seemed to be calmer, especially to those with deeper lesions, as indicated lower postoperative VAS-A scores compared to their preoperative levels, unlike the control group.

CONCLUSION

Our study suggests that the use of AVCs can be an effective method for reducing anxiety in children undergoing class I GIC restoration procedures.

Occlusal veneer restoration treatment outcomes of cracked tooth syndrome: A 22.4-month follow-up study

OBJECTIVES

The aims of this clinical study were to investigate success rate, vital pulp survival rate, tooth survival rate and patient-reported masticatory ability by evaluating the pain symptoms and signs of the cracked teeth as well as Index of Eating Difficulty (IED) and Oral Health Impact Profile-14 (OHIP-14) questionnaire after cracked teeth were restored with occlusal veneers.

MATERIALS AND METHODS

27 cracked teeth of 24 patients with cold and/or biting pains without spontaneous/nocturnal pains were recruited in this study. The cracked teeth were restored with occlusal veneers fabricated by lithium disilicate ceramic. Cold test and biting test were used to evaluate pain signs. IED and OHIP-14 questionnaire were used to evaluate masticatory ability. FDI criteria was used to evaluate restorations. The paired Wilcoxon test was used to analyze significant differences of detection rate of pain signs, OHIP scores and IED grade before and after restorations. Kaplan-Meier survival curve was used to describe the success rate, vital pulp survival rate, and tooth survival rate.

RESULTS

27 cracked teeth were restored with occlusal veneers with average of 22.4-month follow-up. Two cracked teeth had pulpitis and pain signs of the other cracked teeth completely disappeared. OHIP total scores were significantly reduced after treatment. Scores of 'pain', 'occlusal discomfort', 'uncomfortable to eat', 'diet unsatisfactory' and 'interrupted meals' reduced significantly after treatment. After treatment, IED grades of 25 vital teeth were significantly lower than those before treatment. FDI scores of 25 restorations except for 2 teeth with pulpitis were no greater than 2. The 12 months accumulated pulp survival rate of the cracked teeth was 92.6%. The 12 months accumulated tooth survival rate was 100%. The success rate at the latest recall was 92.6%.

CONCLUSION

Occlusal veneer restorations with success rate of 92.6% and the same pulp survival rate might be an effective restoration for treating the cracked teeth.

CLINICAL RELEVANCE

The occlusal veneer restorations might be an option for treating the cracked teeth when cracks only involve enamel and dentin, not dental pulp.

Nanotechnology in Orthodontics: Unveiling Pain Mechanisms, Innovations, and Future Prospects of Nanomaterials in Drug Delivery

Orthodontic pain is characterized by sensations of tingling, tooth discomfort, and intolerance. According to the oral health report, over forty percent of children and adolescents have undergone orthodontic treatment. The efficacy of orthodontic treatment involving braces can be compromised by the diverse levels of discomfort and suffering experienced by patients, leading to suboptimal treatment outcomes and reduced patient adherence. Nanotechnology has entered all areas of science and technology. This review provides an overview of nanoscience, its application in orthodontics, the underlying processes of orthodontic pain, effective treatment options, and a summary of recent research in Nano-dentistry. The uses of this technology in healthcare span a wide range, including enhanced diagnostics, biosensors, and targeted drug delivery. The reason for this is that nanomaterials possess distinct qualities that depend on their size, which can greatly enhance human well-being and contribute to better health when effectively utilized. The field of dentistry has also experienced significant advancements, particularly in the past decade, especially in the utilization of nanomaterials and technology. Over time, there has been an increase in the availability of dental nanomaterials, and a diverse array of these materials have been extensively studied for both commercial and therapeutic purposes.

Introspection of the Etiopathological Mechanisms Underlying Noncarious Cervical Lesions: Analysis of the Different Theories and Their Impact on the Mineralized Structures of the Tooth

The noncarious cervical lesions (NCCLs) recognize an etiological framework of onset very different from the carious processes with etiology whose bacteria aggregated in a biofilm play a predominant role, leading in this way to the loss of the mineralized structure of the tooth. The pathological picture of the NCCLs, which manifests itself with a clinical picture of dental wear, differs from caries because it mainly recognizes a series of pathological processes, such as erosion, through the action of generally acidic chemical agents and abrasion, which is basically expressed through repeated mechanical trauma characteristic of tooth brushing. However, in the literature, there is no unanimous agreement in identifying only these two mechanisms, but there are some who propose a more marked role of anomalous occlusal loads, which would be unloaded on some teeth which, in addition to both erosive and abrasive mechanisms, would give rise to abfraction. Therefore, the aim of this review was to collect literature etio-pathological information and discuss the mechanisms underlying NCCLs.

Effects on different full-coverage designs and materials of crack propagation in first mandibular molar: an extended finite element method study

Objectives: This study aims to investigate the biomechanical properties of fracture resistance in cracked teeth using five different full-coverage restorations made of three different materials. Materials and Methods: A 3D model of a mandibular first molar was created to design five different full-coverage repair models: crown, crown with composite resin filling inside, occlusal veneer, occlusal veneer with composite resin filling inside and onlay. These repair models were fabricated using three different materials, namely, zirconia, lithium disilicate (LDS), and a hybrid polymer-infiltrated ceramic network material (PIC). In total, 15 repair models were tested using the extended finite element method (XFEM), with an occlusal load of 5000 N applied slowly to the occlusal surface of the restoration. The analysis of stress distribution in the restoration and dentin crack line was conducted to measure and record the crack initial load on the restoration and dentin. Results: The results showed that restorations on the occlusal surface significantly improved crack resistance, with zirconia exhibiting superior fracture resistance among the materials tested. Restorations of crown with composite resin filling inside demonstrated the highest resistance to fracture, while occlusal veneers showed the lowest. MPS concentration was observed at the interface between the restoration and dentin and at the root bifurcation, with the highest values at the top of crack development. Dentin covered by oxidized restorations had the highest displacement, while PIC restorations exhibited the lowest. Pulp analysis revealed selective MPS concentration and strain patterns in models with zirconia restorations and onlay, with pronounced pulp displacement in zirconia restorations and onlay. Enamel analysis indicated larger MPS values and displacements in zirconia restoration models and onlay, with higher strain in onlay. Restoration played a crucial role in protecting the tooth, with crack propagation initial loads in dentin surpassing restorations in experimental groups. Conclusion: This study confirms that full-coverage restorations significantly increased the fracture resistance of cracked teeth, with zirconia restorations significantly protecting the underlying cracked tooth. Elimination of fracture lines in the restoration design can improve fracture resistance in cracked teeth. The findings have implications for dental prosthetic design and clinical practice.

Current Applications and Future Directions of Lasers in Endodontics: A Narrative Review

The utilization of lasers has been regarded as a novel technique for the purposes of clinical use in the dental field. Recently, numerous studies have been conducted on the potential applications of laser therapy in endodontics. Moreover, due to their ablation, penetrability, and disinfection capabilities, lasers have performed well with respect to endodontic treatments, including root canal treatment, vital pulp therapy (pulp capping and pulpotomy), dentinal hypersensitivity treatment, and management of dental pain related to pulp and periradicular disease. In particular, the superiorities of laser-aided pulp therapy are emphasized through condensed clinical controlled trials, and histological studies, in this review. Moreover, the ingenious use of laser applications with respect to aiding in the acceleration of root development and the extraction of foreign matters (i.e., broken files and fiber posts) in canals has quickly become the cutting-edge trend of current research. This review offers a summary and discussion of the current literature on all the aforementioned laser applications. Moreover, the characteristics of laser devices, including erbium lasers, neodymium-doped lasers, CO2 lasers, and diode lasers, are detailed and discussed here, providing useful references for laser application in endodontics. We also focus on the different wavelengths with respect to the lasers that are applied in endodontics. High-power lasers perform well as operative instruments; in addition, low-level lasers lead to the regulation of pulp inflammation, and the promotion of pulp healing. This narrative review provides a summary of the advanced applications of lasers in conjunction with various devices in the practice of endodontics, and aims to inspire innovative perspectives on lasers in the context of the treatment of dental diseases, especially pulp diseases, in the future.

[Pain syndrome correction after teeth whitening]

THE AIM OF THE STUDY

Was to develop an algorithm for the correction of pain syndrome using the drug Ketorol Express depending on the level of situational and personal anxiety of patients during office teeth whitening.

MATERIALS AND METHODS

The study involved 60 people (mean age 25±0.85 years), who were divided into three groups depending on the level of personal and situational anxiety according to the Spielberger scale modified by Yu. L. Khanin. In the first group of patients with a high level of anxiety Ketorol Express was prescribed as a preventive analgesia before the whitening procedure, then the drug was used in case of pain. In the second group, patients with an average level of anxiety the drug was prescribed immediately after the whitening procedure, and then used in the event of a pain syndrome. The third group of patients with a low level of anxiety took the drug only in case of pain. To assess the severity of pain, the general well-being by the patient and the general well-being by the doctor, visual analogue scales were used.

RESULTS

The study showed that the occurrence and correction of pain syndrome during teeth whitening depends on the patient's psycho-emotional state (both personal and situational anxiety).

CONCLUSION

The developed regimen for prescribing Ketorol Express can significantly reduce pain in patients with different levels of anxiety.

Efficacy of 810 nm and 650 nm Diode Laser Alone and in Combination With Sodium Fluoride Gel in Treating Dentin Hypersensitivity: A Split-Mouth Randomized Clinical Study

Introduction Dentin hypersensitivity has been defined as a short, sharp pain caused by exposing naked dentin to external stimuli such as evaporation, heat, cold, osmotic liquids, and tactile effects. None of the available treatments has been considered the gold standard in treating dentin hypersensitivity. The use of laser has recently become more popular, and it is a promising treatment method in this field. The study aimed to compare the effectiveness of both 810 nm and 650 nm diode lasers in treating dentin hypersensitivity. Materials and methods This study was conducted on six patients who were referred to the Department of Oral Medicine, Faculty of Dental Medicine, Damascus University (4 females and 2 males) with 108 teeth suffering from generalized dentin hypersensitivity and were randomly divided into two groups. Group 1 consisted of three patients with 50 teeth treated with an 810 nm diode laser; it was divided by the split-mouth design into two subgroups. The first subgroup was treated by the application of the laser alone toward the target area with 1-watt power, continuous mode, and a total application time of 90 seconds, and the second subgroup was treated by applying sodium fluoride gel for one minute, then the laser was applied with the same settings as the first subgroup. Group 2 consisted of three patients with 58 teeth treated with a 650 nm diode laser; it was divided by the split-mouth design into two subgroups. The first subgroup was treated by the application of the laser alone toward the target area with 200 m watt power, continuous mode, and a total application time of 120 seconds, and the second subgroup was treated by applying sodium fluoride gel for one minute and then applying the laser with the same settings as the first subgroup. The pain was evaluated using a numeric rating scale (NRS) of 100 degrees before and immediately after treatment, and then after three to six and nine months by applying an air stream from a dental chair syringe at a distance of 0.5 cm from the target area. Results This study showed that both types of lasers were effective in treating pain caused by dentinal hypersensitivity. The average values ​​of pain reduction on the NRS showed the superiority of the 810 nm diode laser over the 650 nm after treatment and at all time points of pain assessment. No statistically significant differences were detected between applying laser alone and applying it combined with sodium fluoride gel in pain reduction values. Conclusions The application of an 810 nm diode laser either alone or in combination with sodium fluoride gel in treating dentin hypersensitivity is effective and better than the application of a 650 nm diode laser either alone or in combination with sodium fluoride gel. In addition, applying a 650 nm diode laser either alone or in combination with sodium fluoride gel has slight effectiveness in treating dentine hypersensitivity, and it is believed that a single treatment session with a 650 nm diode laser was not enough to obtain the required pain reduction.

Effects of interproximal enamel reduction techniques used for orthodontics: A systematic review

This systematic review aimed to determine the effects of the interproximal enamel reduction (IPR) techniques used in orthodontics. Six databases were searched: PubMed, Scopus, Web of Science, Dentistry & Oral Sciences Source, ScienceDirect and Clinical Trials. Grey literature was sourced from Google Scholar. The risk of bias was assessed by Risk of Bias 2, Newcastle-Ottawa Scale and Robins-I depending on the design of the evaluated study. Additionally, the quality of the included studies was determined using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. This systematic review included randomized clinical trials, non-randomized clinical trials and observational studies with a control group that reported the effects of IPR for orthodontic purposes on the teeth and periodontium. Case reports, and in vitro and in vivo studies were excluded. Eight clinical studies match the eligibility criteria. As a result, no demineralization of the enamel, no increase in caries incidence, no periodontal changes or dental sensitivity was found after IPR. Also, considering the duration of orthodontic treatment, IPR resulted in a quicker technique than dental extractions. At the risk-of-bias assessment, all observational studies showed low risk, the non-randomized clinical trial had a critical bias, and all randomized clinical trials exhibited some concerns. The overall quality of the studies was found to be between low and very low. After the analysis of the data from included studies, it was concluded that the IPR procedures could be useful to treat dental crowding in orthodontic clinical practice without negative effects. However, more randomized controlled clinical trials with a longer follow-up time and high-quality studies are required to generate robust statements.

Phototherapy Using Er,Cr:YSGG Laser as a Definitive Treatment for Dentin Hypersensitivity: A Systematic Review

Purpose

To assess the efficacy of Er,Cr:YSGG lasers in reducing dentine hypersensitivity (DH).

Methods

Electronic literature were searched through various databases (MEDLINE, SCOPUS, ProQuest, LILACS and EBSCO) up to March 2022 for articles addressing the following focused question: “In patients with dentine hypersensitivity, does an Er,Cr:YSGG laser provide a better outcome in terms of pain reduction than other dentine desensitizer agents?”. The literature was searched using combinations of the following medical subject heading (MeSH) terms and keywords: (laser OR phototherapy OR Er,Cr:YSGG laser) AND (dentine hypersensitivity OR dentine sensitivity OR dental sensitivity).

Results

A total of 486 studies were found, of which 7 randomized controlled trials were included in the review. The Er,Cr:YSGG laser wavelengths, power density and duration of irradiation used in the studies were 2780 nanometers, 0.25–0.5 watts and 20–60 seconds, respectively. The follow-up assessments were conducted ranging from immediately to 3 months after treatment. All studies showed that the Er,Cr:YSGG laser was effective in alleviating DH.

Conclusion

This systematic review suggests that the application of an Er,Cr:YSSG laser is effective in alleviating DH and may have limited adverse effects if adequate parameters are followed.

Advances in the Management of Dentin Hypersensitivity: An Updated Review

Background:

Objective: The objective of this narrative review is to present an overview of dentin hypersensitivity and of the prevalence, etiology, mechanism, diagnosis, and clinical management.

Methods:

Available articles (research, reviews, commentary, views, or editorial) on hypersensitivity were searched and reviewed from January 1990 till March 2021 in Pubmed, Scopus, Google Scholar, and Science Direct. Relevant studies in English were included and critically analyzed in this article.

Results:

Dentin hypersensitivity causes severe pain. The most effective and least invasive remedy is using desensitizing toothpaste. In addition, based on the dentin hypersensitivity severity, management can be done professionally in-office and through self-applied at-home treatments.

Conclusion:

Although dentin hypersensitivity causes severe pain, it can be treated using a proper remedy. Correct diagnosis helps in the proper management of dentine hypersensitivity.

Management of dentinal hypersensitivity should be done with more conservative strategies first, followed by irreversible dental interventions.

Clinical efficacy of hydroxyapatite toothpaste containing Polyol Germanium Complex (PGC) with threonine in the treatment of dentine hypersensitivity

Introduction

This study aims to evaluate the clinical efficacy of a hydroxyapatite toothpaste containing a Polyol Germanium Complex with threonine in treating dentine hypersensitivity. The study also seeks to monitor the quality of life of the treated dentine hypersensitivity sufferers.

Materials and methods

This study is a randomized clinical trial with a total of 120 patients with dentine hypersensitivity. All participants were divided into three groups: patients assigned to the GARDA SILK toothpaste; patients receiving the conventional fluoride toothpaste for comparison purposes, and patients asked to brush their teeth without toothpaste. The modified Quigley-Heine Plaque Index was assessed at the baseline and after treatment. Sensitivity was assessed at baseline, 3, 7 and 14 days using the air stimulus (Schiff Index). The impact of dentine hypersensitivity on the quality of life was assessed before and after the treatment with the Russian version of the Dentine Hypersensitivity Experience Questionnaire (DHEQ).

Results

After 14 days of treatment, the mean Plaque Index scores in Groups 1 and 2 did not exceed 1 and averaged 0.72 ± 0.249 and 0.86 ± 0.213, respectively. In Group 3, the mean Plaque Index was significantly higher (1.04 ± 0.070, p < 0.05). The mean Schiff sensitivity scores in Group 1 decreased to 2.45 ± 0.42 at 3 days, 1.84 ± 0.26 at 7 days, and 1.02 ± 0.34 at 14 days. Group 2 exhibited smaller reductions in the Schiff index at all time points. In this group, Schiff scores dropped to 2.67 ± 0.28 after 3 days, 2.34 ± 0.44 after 7 days, and 1.93 ± 0.36 after 14 days.

Conclusion

The GARDA SILK hydroxyapatite toothpaste with a threonine-containing Polyol Germanium Complex (PGC) is effective in maintaining good oral hygiene, reducing dentine hypersensitivity, and improving the quality of life of dentine hypersensitivity sufferers.

3D Printed In Vitro Dentin Model to Investigate Occlusive Agents against Tooth Sensitivity

Tooth sensitivity is a painful and very common problem. Often stimulated by consuming hot, cold, sweet, or acidic foods, it is associated with exposed dentin microtubules that are open to dental pulp. One common treatment for tooth hypersensitivity is the application of occlusive particles to block dentin microtubules. The primary methodology currently used to test the penetration and occlusion of particles into dentin pores relies upon dentin discs cut from extracted bovine/human teeth. However, this method is limited due to low accessibility to the raw material. Thus, there is a need for an in vitro dentin model to characterize the effectiveness of occlusive agents. Three-dimensional printing technologies have emerged that make the printing of dentin-like structures possible. This study sought to develop and print a biomaterial ink that mimicked the natural composition and structure of dentin tubules. A formulation of type I collagen (Col), nanocrystalline hydroxyapatite (HAp), and alginate (Alg) was found to be suitable for the 3D printing of scaffolds. The performance of the 3D printed dentin model was compared to the natural dentin disk by image analysis via scanning electron microscopy (SEM), both pre- and post-treatment with occlusive microparticles, to evaluate the degree of dentinal tubule occlusion. The cytocompatibility of printed scaffolds was also confirmed in vitro. This is a promising biomaterial system for the 3D printing of dentin mimics.

The combined use of systemic analgesic/anti-inflammatory drugs and a bioactive topical desensitizer for reduced in-office bleaching sensitivity without jeopardizing the hydrogen peroxide efficacy: a randomized, triple blinded, split-mouth clinical trial

OBJECTIVE

To evaluate the effect of combined systemic administration of paracetamol 500 mg/codeine phosphate 30 mg (PACO) and postoperative topical application of a bioactive desensitizer on in-office bleaching sensitivity and tooth color change.

MATERIALS AND METHODS

A randomized, triple-blind, split-mouth clinical trial was conducted. Forty volunteers ingested PACO (n = 20) or placebo (PLA) (n = 20). Their left/right hemiarches received topical application of a bioactive desensitizer [Nano-P™(NP)] and prophylactic paste (PAS), generating four treatment approaches: PACO/NP, PACO/PAS, PLA/NP, and PLA/PAS. Two bleaching sessions (35% hydrogen peroxide) were performed, and the PAS/NP were applied after the procedure. Sensitivity was obtained since the first bleaching session up to 7 days post-bleaching. The color change was evaluated using CIEDE2000 and whiteness index parameters up to 7 days post-bleaching. Data were analyzed using one- and two-way ANOVA/Tukey post hoc tests (p < 0.05).

RESULTS

The PLA/PAS showed a sensitivity average of at least two times higher than the PACO/NP. The treatment approaches promoted statistically similar bleaching patterns (p > 0.05).

CONCLUSION

The combined approach of systemic administration of PACO and postoperative topical application of NP reduced the level of in-office bleaching sensitivity without jeopardizing hydrogen peroxide efficacy.

CLINICAL RELEVANCE

Professionals can adopt the combined approach of systemic administration of analgesic/anti-inflammatory drugs and topical application of a bioactive desensitizer for decreased bleaching sensitivity caused by 35% hydrogen peroxide in-office.