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Background: Lymphomas of parapharyngeal space often have complex manifestations, posing a diagnostic dilemma for clinicians., Case Description: A 64-year-old man sought treatment for a 4-month history of unresolving right-sided headache and jaw pain associated with syncope, all of which started with a toothache. Since the onset of pain, the patient had undergone multiple diagnostic tests with various specialists, with no pain relief. A detailed clinical and radiologic examination by an orofacial pain specialist revealed diffuse large B-cell lymphoma in the parapharynx., Practical Implications: A thorough knowledge of the head and neck anatomy helps in identifying the pathophysiology of complex orofacial pain manifestations, which assists in early diagnosis and treatment., Competing Interests: Disclosures None of the authors reported any disclosures., (Copyright © 2024 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Background: The purpose of this investigation was to identify evidence-based clinical trials to aid dental clinicians in establishing the efficacy for recommending or prescribing analgesics for pain of endodontic origin., Types of Studies Reviewed: The authors prepared and registered a protocol on PROSPERO and conducted electronic searches in MEDLINE, Scopus, the Cochrane Library, and ClinicalTrials.gov. In addition, the authors manually searched the bibliographies of all relevant articles, the gray literature, and textbooks for randomized controlled trials. Two authors selected the relevant articles independently. There were no disagreements between the authors., Results: The authors analyzed 27 randomized, placebo-controlled trials. The authors divided the studies into 2 groups: preoperative and postoperative analgesic treatments. There was moderate evidence to support the use of steroids for patients with symptomatic irreversible pulpitis. Also, there was moderate evidence to support nonsteroidal anti-inflammatory drugs (NSAIDs) preoperatively or postoperatively to control pain of endodontic origin. When NSAIDs were not effective, a combination of NSAIDs with acetaminophen, tramadol, or an opioid appeared beneficial., Conclusions and Practical Implications: NSAIDs should be considered as the drugs of choice to alleviate or minimize pain of endodontic origin if there are no contraindications for the patient to ingest an NSAID. In situations in which NSAIDs alone are not effective, the combination of an NSAID with acetaminophen or a centrally acting drug is recommended. Steroids appear effective in irreversible pulpitis., (Copyright © 2016 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Background: The authors undertook a study involving members of a dental practice-based research network to determine the outcome and factors associated with success and failure of endodontic therapy., Methods: Members in participating practices (practitioner-investigators [P-Is]) invited the enrollment of all patients seeking treatment in the practice who had undergone primary endodontic therapy and restoration in a permanent tooth three to five years previously. If a patient had more than one tooth so treated, the P-I selected as the index tooth the tooth treated earliest during the three- to five-year period. The authors excluded from the study any teeth that served as abutments for removable partial dentures or overdentures, third molars and teeth undergoing active orthodontic endodontic therapy. The primary outcome was retention of the index tooth. Secondary outcomes, in addition to extraction, that defined failure included clinical or radiographic evidence (or both) of periapical pathosis, endodontic retreatment or pain on percussion., Results: P-Is in 64 network practices enrolled 1,312 patients with a mean (standard deviation) time to follow-up of 3.9 (0.6) years. During that period, 3.3 percent of the index teeth were extracted, 2.2 percent underwent retreatment, 3.6 percent had pain on percussion and 10.6 percent had periapical radiolucencies for a combined failure rate of 19.1 percent. The presence of preoperative periapical radiolucency with a diagnosis of either irreversible pulpitis or necrotic pulp was associated with failure after multivariate analysis, as were multiple canals, male sex and Hispanic/Latino ethnicity., Conclusions: These results suggest that failure rates for endodontic therapy are higher than previously reported in general practices, according to results of studies based on dental insurance claims data., Clinical Implications: The results of this study can help guide the practitioner in deciding the most appropriate course of therapy for teeth with irreversible pulpitis, necrotic pulp or periapical periodontitis.

Background: Atypical odontalgia (AO) is a poorly understood and commonly misdiagnosed condition for which patients often undergo multiple unsuccessful dental or surgical procedures. The authors conducted a study to determine the prevalence and describe the characteristics of patients with AO seen at the University of Southern California Orofacial Pain and Oral Medicine Center (USC OFP-OM Center), Los Angeles., Methods: The authors conducted a retrospective record review from a database of more than 3,000 patient records from June 2003 to August 2007 to identify patients diagnosed with AO., Results: The authors identified 64 patients (44 women and 20 men) between the ages of 26 and 93 years as having a diagnosis of AO. Of those 64 patients, 71 percent initially consulted a dentist regarding their pain, and 79 percent had undergone dental treatment that failed to resolve the pain. The pain of 64 percent of the patients had no known cause., Conclusions: Dentists, who often are the first health care providers to see patients with AO, must be aware of this condition and must follow the appropriate steps to determine its diagnosis., Clinical Implications: Dentists and physicians should understand the implications and importance of early diagnosis of patients with AO and of referral to pain specialists for treatment.

Background: Referred pain is prevalent in the craniofacial region, and it would be helpful for dental practitioners to have drawings delineating regions with a high probability for a patient's referred pain source., Methods: The author applied firm pressure for approximately five seconds to trigger points, nodules of spot tenderness, and selected masticatory structures within the head and neck region on 230 patients with temporomandibular disorder, or TMD. As firm pressure was being applied, subjects were asked whether pain was developing or intensifying in a location different than that being palpated., Results: One hundred ninety-six subjects (85 percent) reported that referred pain was being generated. The cheek area, ear and forehead were the most frequently reported sites of referred pain generation; palpation over the trapezius muscle, lateral pterygoid area and masseter muscle were the most common sources of referred pain to the craniofacial region. The author provides figures displaying common referred pain sites and their sources., Conclusions: Patients with TMD often report referred craniofacial pain arising from palpation of the head and neck region. The author found that the pattern between referred pain source and site was consistent and predictable., Practice Implications: Practitioners should consider craniofacial pain's propensity for referral when treating patients with TMD. Practitioners can use the figures presented to determine regions of high probability for a patient's referred pain source.

Background: This clinical study compared the efficacy of adhesive-retained vs. pin-retained complex amalgam restorations in the treatment of molars with incomplete fractures. Both relief of chewing pain and cold sensitivity were evaluated at two weeks, three months and one year., Methods: The authors treated 38 patients with a chief complaint of chewing sensitivity on vital molar teeth (40 teeth in the study). A random-number generator determined the treatment method for each tooth. Twenty teeth received bonded amalgam restorations. Twenty teeth received amalgapins or threaded pins to retain the amalgam. Teeth were evaluated for postoperative chewing sensitivity. A visual analog pain scale was used to evaluate cold response to a skin-refrigerant-soaked cotton pellet at each visit. After 12 months, all 40 teeth were available for evaluation., Results: Chewing pain was completely eliminated in all but one tooth. A Student's t-test found no significant difference (P > .05) in preoperative cold sensitivity between the bonded and nonbonded groups. A paired t-test comparison indicated that the teeth in the bonded group were significantly less sensitive to cold after three months and 12 months than they were at the time of the baseline measurements (P < .0001). A paired t-test indicated no significant difference between preoperative and postoperative cold sensitivity scores for teeth in the nonbonded group (P > .05)., Conclusions: Both adhesively bonded and mechanically retained complex amalgam restorations were successful in resolving chewing sensitivity in cracked molars. For 39 of 40 teeth, chewing sensitivity did not return during the one-year follow-up period. At three months and 12 months, cold sensitivity was reduced in the bonded restorations. At all three time periods, cold sensitivity remained similar to baseline levels for the mechanically retained restorations., Clinical Implications: Incomplete tooth fracture in molars can be successfully treated by covering fractured cusps with amalgam restorations. This study excluded teeth with prolonged sensitivity to a cold stimulus or those with periodontal evidence of root fracture. With these exclusions, elimination of chewing sensitivity was predictable. Teeth restored with bonded restorations experienced a decrease in sensitivity to a cold stimulus at three months and at 12 months, but not at two weeks. The cold sensitivity of teeth restored with nonbonded restorations was similar at baseline, two weeks, three months and one year.

Background: Although periodontal scaling and root planing, or SRP, is one of the most common procedures used in dental practice, there is little information available about the degree of postprocedural pain associated with it. The authors undertook this study to document the intensity and duration of pain after SRP with a view toward helping practitioners and their patients manage postprocedural discomfort., Methods: Using the Heft-Parker self-assessment pain scale, 52 adults with moderate periodontitis evaluated their pain before and after SRP conducted with local anesthetic., Results: After SRP, 28 percent of all patients reported faint-to-weak pain, 18 percent experienced weak-to-mild pain, 28 percent experienced mild-to-moderate pain, 8 percent had moderate-to-strong pain and 8 percent reported strong-to-intense pain. The average time to onset of maximum pain was approximately three hours after SRP, and the average duration of mild or greater pain was about six hours. Upon awakening the morning after SRP, subjects found that pain had returned to pre-SRP levels. Overall, 23 percent of all patients reported self-medicating with analgesics to relieve postprocedural pain. Women self-medicated earlier (P < .05) and more often than men (43 percent vs. 10 percent; P < .05)., Conclusions: Patients experienced significant duration and magnitude of pain after SRP. This pain peaked between two and eight hours after SRP, lasted about six hours, and returned to pre-SRP levels by the morning after the procedure. Almost 25 percent of all patients self-medicated to relieve pain after SRP, and women took analgesic medication earlier and more often than men., Clinical Implications: Practitioners should consider using appropriate analgesic drugs to alleviate mild-to-moderate pain after SRP. On the basis of this study, it would appear that an analgesic that has a peak effect two to eight hours after the completion of SRP would be the most appropriate medication. Moreover, it is unlikely that analgesic medication would be needed by most patients beyond the day on which SRP was performed.

Background: Hardly any data are available concerning the chief complaints, or CCs, of patients with periodontitis. The authors conducted a study to determine the most common CCs among a group of subjects with periodontitis., Methods: The authors examined the dental records of 191 patients with periodontitis to determine what CCs they orally reported having at an initial examination. Patients were referred mainly by other members of the dental health team. Eighty percent of the patients were diagnosed with moderate or moderate-to-severe periodontitis. The authors recorded the frequency of different CCs to determine the most common complaints., Results: The authors recorded 336 CCs from the records of 191 subjects with periodontitis. There were 21 different CCs. The most common CC reported was, "I was told I have gum disease." The second most common CC reported was, "I would like to save my teeth." Neither of these CCs are true periodontitis symptoms. Bleeding gums--a true periodontitis symptom--was the third most common CC. Only 6.2 percent of the subjects reported having painful gingiva, and only 29.3 percent of the subjects reported having dental-emergency-related CCs., Conclusions: The authors found that the motivation to seek periodontal treatment was most commonly based on information given to the subjects by a member of the dental health team, rather than a periodontitis symptom., Clinical Implications: Renewed efforts and increased responsibility of the dental health team members to inform patients about the presence of periodontitis are needed, as well as emphasizing to the public the risk of losing teeth as a result of periodontitis.

The authors review the literature and present a case of cracked tooth syndrome. Special emphasis is placed on diagnostic problems associated with this syndrome. The case report demonstrates classic and atypical features of cracked tooth syndrome.

Developing a treatment strategy for patients who are in chronic pain can be challenging for any health care professional, particularly when traditional measures to relieve pain are ineffective. Pain treatment can be further complicated by phenomena known as phantom pain--most often associated with limb amputation. The author describes three phantom syndromes experienced in the orofacial region: phantom tooth pain, phantom bite syndrome and intraoral stump pain.

Many studies have documented pulpal sensitivity after crown cementation, but none have determined its cause. By controlling technique variables in a large-scale clinical trial, the authors evaluated the contribution of zinc phosphate and glass ionomer luting cements in causing pulpal sensitivity or necrosis.

A case of oral herpes zoster infection with prodromal odontalgia is presented. Tooth devitalization, facial scarring, and neuralgia occurred without concurrent local and systemic factors. The cause, pathological features, diagnosis, and management of an oral herpes zoster infection with prodromal odontalgia are discussed.

Within 24 hours after dental treatment, discomfort was experienced by 78% of the patients questioned. Sensitivity to cold was the most frequent type of discomfort experienced (reported by 50% of the patients). Postoperative discomfort resulting from cold stimulus was most often mild (in 78%), occasionally moderate (in 22%), and never severe. The duration of postoperative discomfort resulting from cold stimulus was most often fleeting (reported by 94%) and seldom prolonged (reported by 6%). The second most frequent type of postoperative discomfort reported was associated with the administration of the local anesthetic. Sensitivity to sweets does not seem to be a source of postoperative discomfort following routine operative dental procedures.

The results of this study add to the previous findings on the cracked tooth syndrome. Treatment to prevent further cracking is a must. Dentists should be aware of the syndrome and, after making the diagnosis, initiate necessary treatment.

The role of routine medical examination in dental diagnosis is described in a report of case involving a young, seemingly healthy patient whose only symptom, pain in the mandibular left molars, proved a manifestation of a malignant mediastinal lymphoma.

Persons susceptible to barodontalgia include those with peridontal abscesses, carious teeth, maxillary sinus congestion, or those who have had recent extractions or restorations. A 38-year-old man had acute pain while he was in a depressurized chamber. Treatment of a periodontal abscess alleviated the problem.

Three cases of jaw pain recurrently precipitated by consumption of alcohol are described. Alcohol-induced neuralgia is added to the differential diagnosis of atypical orofacial pain.