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Accurately diagnosing the state of dental pulp is crucial when addressing tooth pain to determine the best treatment approach. This study aimed to investigate the concentration of inflammatory mediators in the dental pulp of mature teeth that have been exposed via caries but show no signs of apical periodontitis. Samples of pulpal blood from adults with mature teeth responsive to pulp testing and have carious pulp exposures were obtained. These samples were analyzed for 12 inflammatory cytokines and other inflammatory proteins using the Luminex assay platform. Clinical factors were correlated with cytokine levels, and statistical analysis was performed to evaluate the impact of these factors on cytokine expression. Of the 36 patients that were included, 44.44% took pain medications, 33.33% had prolonged pulpal bleeding, 41.67% felt spontaneous pain, and 72.22% were diagnosed with symptomatic irreversible pulpitis. Significant correlations existed between presenting pain scores and levels of interleukin (IL)-1α, IL-6, and IL-8 (P <.05). Factors like analgesic medication intake, pain to percussion, pain to thermal testing, spontaneous pain, and nocturnal pain were significantly associated with higher levels of specific inflammatory proteins. No significant associations were observed with pain to palpation, bleeding time, or pulpal diagnosis. Inflammatory proteins, including cytokine levels may play a critical role in characterizing pulpal inflammation. Future studies should investigate the role of these potential biomarkers in determining the diagnosis of pulpitis and the prognosis of vital pulp therapy. [ABSTRACT FROM AUTHOR]

This study assessed the accuracy of a TMD Pain Screener questionnaire in identifying patients with temporomandibular disorder (TMD) pain among those seeking endodontic treatment for tooth pain. It also investigated whether the screener accuracy could be improved by adding questions regarding putative predictors of TMD status. One hundred patients seeking endodontic treatment for tooth pain were enrolled. Participants completed the 6-question TMD Pain Screener before treatment. A board-certified orofacial pain specialist/endodontic resident conducted endodontic and TMD examinations using validated Diagnostic Criteria for TMD (DC/TMD). The sensitivity (Se), specificity (Sp), and positive/negative predictive values (PPVs/NPVs) were calculated for the 6-question and 3-question versions of the TMD Pain Screener. Logistic regression and receiver operating characteristic curve (AUROC) analyses were performed to determine the screening accuracy. At the screening threshold of ≥3, TMD Pain Screener's sensitivity was 0.85, specificity 0.52, PPV 0.68, and NPV 0.75 for the 6-question version and 0.64, 0.65, 0.69, and 0.61, respectively, for the 3-question version. The AUROC was 0.71 (95% CL: 0.61, 0.82) and 0.60 (95% CL: 0.48, 0.71) for full and short versions, respectively. Adding a rating of current pain intensity of the chief complaint to the screener improved the AUROC to 0.81 (95% CL: 0.72, 0.89) and 0.77 (95% CL: 0.67, 0.86) for full and short versions, respectively, signifying useful overall accuracy. The 6-question TMD Pain Screener, combined with the patient's rating of current pain intensity of the chief complaint, could be recommended for use in endodontic patients with tooth pain for detecting painful TMD. [ABSTRACT FROM AUTHOR]

Acute dental pain is a common issue leading to dental consultation. Besides causal therapy, patients are treated with acupuncture, but efficacy in acute dental pain is still not clarified. We aimed to evaluate results of recent research to estimate the efficacy of acupuncture compared to pain-relieving approaches in treatment of acute dental pain. A systematic review of controlled trials being published between database inception and 2020 were conducted to evaluate the efficacy of acupuncture (alone or as complementary therapy) compared to local anesthesia or conventional analgesic medications in acute dental pain (intraoperatively and postoperatively) and to clarify whether acupuncture reduces the use of postoperative analgesic medications. Of 1672 publications, 23 publications met the inclusion criteria. From these, 11 randomized controlled trials (n = 668) reported on the efficacy of acupuncture on postoperative acute dental pain. Patients, who received acupuncture, showed lower pain scores postoperatively compared to sham acupuncture (Relative Risk −0.77, 95% Confidence interval −1.52 to −0.03). Overall, the results suggest a potential role of acupuncture in improving acute dental pain intraoperatively and postoperatively as well as improving the efficacy of local anesthesia, but the results are limited due to methodological shortcomings emphasizing the necessity for future high-quality research. [ABSTRACT FROM AUTHOR]

Emerging research has revealed that the activation of the NLR family pyrin domain containing 3 (NLRP3) inflammasomes contribute to the development of inflammatory and neuropathic pains. In addition, microglia are involved in the central nervous system (CNS) pain conduction. However, the relationship between NLRP3 inflammasome and dental inflammatory pain conduction is yet to be established. Therefore, this study aimed to investigate the roles of P2X7 and NLRP3/Caspase-1 (CASP1) in the inflammatory pain caused by pulpitis using a rat experimental pulpitis model. We discovered that the decreased pain threshold was inversely correlated with the increased expression of NLRP3, Caspase-1, P2X7, interleukin-1β (IL-1β), and IL-18 in the trigeminal ganglion and dorsal horn of the medulla after dental pulp exposure. Furthermore, the pain threshold of rats caused by pulpitis was increased by intraperitoneal injection of Brilliant Blue G (BBG), a P2X7 inhibitor, and the expression levels of NLRP3 and related inflammatory factors IL-1β and IL-18 were decreased. Moreover, treatment with 130 nM KCl, a P2X7 inhibitor, significantly reduced the expression of NLRP3, IL-1β, IL-18, Caspase-1, and P2X7 in microglia after lipopolysaccharide(LPS) stimulation. In conclusion, our findings suggest that NLRP3/ CASP1 plays a vital role in the conduction of dental pain; the P2X7regulates NLRP3 pathway in the context of dental inflammatory pain conduction, and inhibiting P2X7 may be a potential strategy for dental inflammatory pain relief. • NLRP3 and P2X7 in MDH were positive correlated with pulpitis pain. • Inhibition of P2X7 downregulated NLRP3/CASP1 mediated IL-1β and IL-18. • P2X7 presents a potential anti-nociceptive target in pulpitis pain. [ABSTRACT FROM AUTHOR]

On the 25 March 2020 the Chief Dental Officer (CDO) published guidance to restrict the provision of routine dental care in England due to the rapid spread of the severe acute respiratory syndrome Coronavirus 2 (COVID-19). We analysed the impact of the pandemic on the number of patients presenting with odontogenic pain and infection to the emergency department (ED) of an urban-based teaching hospital, the Bristol Royal Infirmary (BRI). Furthermore, we investigated the severity of infection at first presentation to the ED. The study period encompassed three phases that represented the stages of pandemic restrictions: phase 1 prior to lockdown measures, with no restrictions to dental practice; phase 2 during the government lockdown, with the severest restrictions on dental practices; and phase 3 following the ease of lockdown measures, with return to limited dental services. Data were collected retrospectively from electronic patient records (EPR) regarding adult patients presenting to the ED with dental pain. The rate of presentations (per week) was calculated for each timepoint and compared. A severity score was assigned to each patient using a grading system based on signs of clinical infection and treatment modality. Patients' presentations were analysed at each phase of the pandemic. There was a 42.8% increase in attendance with oral facial pain and infection to ED from phases 1 to 3. The COVID-19 pandemic resulted in restrictions to routine primary dental care services, which were deemed necessary to reduce the spread of the virus. However, this increased demand on secondary care services, as patients increasingly struggled to access primary dental care to manage dental pain. [ABSTRACT FROM AUTHOR]

Information on the type of vesicular glutamate transporter (VGLUT) that is expressed in the Piezo2-positive (Piezo2+) neurons in the trigeminal ganglion (TG) and on the type of Piezo2+ axons and their distribution in the dental pulp is important for understanding dental pain elicited by mechanical stimuli and developing new therapeutic strategies. We examined the expression of Piezo2 and its coexpression with VGLUT1 and VGLUT2 in rat TG, the sensory root, and human dental pulp using light and electron microscopic immunohistochemistry and quantitative analysis. VGLUT1 and VGLUT2 were expressed in the TG neurons. Piezo2 was expressed in axons of all types but primarily in small myelinated (Aδ) axons in the sensory root. In the dental pulp, Piezo2 was expressed densely in the numerous axons that form a plexus in the peripheral pulp. Piezo2+ axons in the peripheral pulp were mostly unmyelinated, and Piezo2 immunoreactivity was often concentrated near the axolemma, suggesting that it may represent functional receptors. These findings suggest that VGLUT1 and VGLUT2 are involved in the glutamate signaling in Piezo2+ neurons, Piezo2 may be primarily activated by noxious mechanical stimuli, and Piezo2-mediated dental mechanotransduction may be primarily elicited in the peripheral pulp. [ABSTRACT FROM AUTHOR]

• Acidification is induced in the gingival sulcus of mechanically forced tooth. • Buffering the gingival acidity ameliorates orthodontic mechanical allodynia. • ASIC3 is involved in the mechanical allodynia induced by orthodontic force. • Tooth movement causes ASIC3 phosphorylation in the periodontal tissue. Tooth movements associated with orthodontic treatment often cause tooth pain. However, the detailed mechanism remains unclear. Here, we examined the involvement of periodontal acidification caused by tooth movement in mechanical tooth pain hypersensitivity. Elastics were inserted between the first and second molars to move the teeth in Sprague-Dawley rats. Mechanical head-withdrawal reflex threshold to first molar stimulation and the pH of the gingival sulcus around the tooth were measured. The expression of acid-sensing ion channel 3 (ASIC3) in trigeminal ganglion neurons and phosphorylation of ASIC3 in the periodontal tissue were analyzed. The mechanical head-withdrawal reflex threshold to first molar stimulation and pH in the gingival sulcus decreased on day 1 after the elastic insertion. These decreases recovered to the sham level by buffering periodontal acidification. Periodontal inhibition of ASIC3 channel activity reversed the decreased mechanical head-withdrawal reflex threshold to first molar stimulation. On day 1 after elastic insertion, the tooth movement did not change the number of ASIC3 immunoreactive trigeminal ganglion neurons innervating the periodontal tissue but increased phosphorylated-ASIC3 levels in the periodontal tissue. Periodontal acidification induced by tooth movement causes phosphorylation of ASIC3, resulting in mechanical pain hypersensitivity in mechanically forced tooth. [ABSTRACT FROM AUTHOR]

Although many clinical studies have reported on the prevalence of dental pain, far fewer studies have focused on the mechanisms of dental pain. This is an important gap because increased understanding of dental pain mechanisms may lead to improved diagnostic tests or therapeutic interventions. The aim of this study was to comprehensively review the literature on the mechanisms of dentinal sensitivity. PubMed and Ovid were searched for articles that addressed dentinal pain and or pulpal sensitivity. Because of the breadth of research ranging from cellular/molecular studies to clinical trials, a narrative review on the mechanisms of dentinal sensitivity was constructed based on the literature. Five various mechanisms for dentinal sensitivity have been proposed: (1) the classic hydrodynamic theory, (2) direct innervation of dentinal tubules, (3) neuroplasticity and sensitization of nociceptors, (4) odontoblasts serving as sensory receptors, and (5) algoneurons. These theories are not mutually exclusive, and it is possible that several of them contribute to dentinal sensitivity. Moreover, pulpal responses to tissue injury may alter the relative contribution of these mechanisms. For example, pulpal inflammation may lead to neuronal sprouting and peripheral sensitization. Knowledge of these mechanisms may prompt the development of therapeutic drugs that aim to disrupt these mechanisms, leading to more effective treatments for pulpal pain. [ABSTRACT FROM AUTHOR]

Background: During the coronavirus pandemic, paediatric patients will still likely present with dental pain and infection. In order to streamline care at King's College Hospital (KCH), Paediatric Dentistry and Oral and Maxillofacial Surgery (OMFS) have developed a collaborative working approach allowing patients to be treated effectively and to streamline patient care in the absence of easy access to general anaesthetic facilities.Method: Presenting complaints, treatment need and the treatment received were recorded for all paediatric patients presenting with dental pain and infection in the "lockdown" period (23rd March- 14th June) during "normal" working hours and "out of hours" to either paediatric dentistry or OMFS.Results: 420 calls were triaged which converted to 67 patients seen face-to-face for oro-facial pain and infection. 41% of children were treated successfully under Local anaesthetic alone, only 13% required a general anaesthetic (GA) in the "lockdown" period. The vast majority of patients had antibiotics prescribed prior to attendance (80%).Conclusion: We have demonstrated the demographic, presenting complaints and treatment need of patients who presented to KCH during the lockdown period with dental pain and infection. The majority were able to be treated without needing for GA facilities. This paper highlights how a collaborative approach between paediatric dentistry and OMFS can help streamline patient care and is a model which can be adopted by other units in the event of further "lockdowns". [ABSTRACT FROM AUTHOR]

Marfan syndrome (MFS) is a life-threatening connective tissue disorder that affects multiple organs and systems. We report a case of MFS with recurrent lower left posterior toothache as the first symptom. A 23-year-old Asian man walked into the dental emergency room with a chief complaint of recurrent spontaneous and intermittent toothache in his lower left posterior tooth region, mimicking acute symptomatic pulpitis. He self-reported a relatively healthy medical status without any hereditary disease. However, his disproportionately elongated body structure, high myopia, and positive wrist sign were immediately recognizable. Although there were no remarkable findings on the dental examination, pectus carinatum deformity and abnormal blood pressure were later detected. He was immediately referred to a cardiologist in a medical hospital. The timely diagnosis of MFS and early surgical intervention helped to avoid severe lethal consequences. The symptoms of toothache completely resolved after surgery. [ABSTRACT FROM AUTHOR]

The present study was designed to compare the efficiency of 4% articaine with epinephrine 1:100,000 and 2% lidocaine with epinephrine 1:100,000 in providing adequate anaesthesia for maxillary molar extraction with buccal infiltration only. In this randomised, double-blind clinical trial, 139 patients who needed maxillary molars extracting were enrolled. Individuals were randomly divided into two groups of 2% lidocaine with epinephrine 1:100,000 treated by buccal infiltration without palatal injection and 4% articaine with epinephrine 1:100,000 treated with the same method. Then, teeth were extracted and the pain assessed. During the extraction of teeth, 90.63% of patients in the lidocaine-treated group and 36% of patients in the articaine-treated group experienced pain (p<0.0001). In other words, the rates of successful anaesthesia with lidocaine and articaine buccal infiltration were 9.38% and 64%, respectively. Despite the better performance of articaine, it seems that some factors such as bone thickness and anatomical variations among individuals, besides the condition of the tooth, affects articaine's level of efficiency in each case. [ABSTRACT FROM AUTHOR]

The dentist's main working area is the head and neck region, which is innervated by the cranial nerves. On a daily basis, dentists must administer local anaesthesia to ensure pain-free treatment and differentiate between dental pain and neuropathies to avoid mistreatment. Therefore, neuroanatomical training, especially on the cranial nerves, is of immense importance for clinical practice. In order to adopt the curriculum, it is essential to constantly evaluate the quality of the training and to investigate whether there is a correlation between the students' performance and the relevance of the subfields to their work. To address this issue, the results of MC exams in the neuroanatomy course for dental students at Charité-Universitätsmedizin Berlin from winter semester 2014/2015 to winter semester 2019/2020 were analysed. Each question was assigned to a specific subfield of neuroanatomy. We then compared cranial nerves and cranial nerve nuclei (clinically relevant) with the remaining subfields (clinically less/not relevant) to investigate whether students performed better in anatomy subfields that are more aligned with the clinical practice of a dentist. We also conducted an anonymous survey (n=201) of the dental students. From winter semester 2014/2015 to winter semester 2019/2020, students performed significantly (***, p< 0.001) better on the clinically relevant questions of the MC examination than on the less/not clinically relevant questions. However, when looking at each of the eleven semesters separately, only three semesters actually performed significantly better on the clinically relevant questions. Our survey also showed that students perceived the subfield of cranial nerves and cranial nerve nuclei to be the most relevant and studied it more intensively out of their own interest. The study showed that students perceived the subfield of cranial nerves and cranial nerve nuclei to be the most relevant. However, there was no direct correlation between student performance and clinically relevant questions. Using student performance alone as an indicator of relevance is not optimal, as factors such as motivation to learn can have a significant impact. Greater clinical relevance influences what students learn more intensively out of their own interest, but does not influence the results of the MC examination in favour of the subspecialty. Based on the available evidence, it is recommended that the structure of the neuroanatomy course be reconsidered. [ABSTRACT FROM AUTHOR]

Background: Dental infections are frequently encountered in the emergency department (ED), with periapical abscesses being among the most painful. Traditional pain management strategies include local anesthetic injections, oral analgesics, and intravenous opioids.Objectives: We sought to identify an alternative pain management strategy with early use of dexamethasone as adjunct to conventional therapies for inflammation and pain at the site of infection.Methods: We conducted a prospective, randomized, double-blind, placebo-controlled study comparing the analgesic effect of dexamethasone and placebo in ED patients with periapical abscess during a 2-year timeframe at two urban academic EDs. Adult patients presenting with physical examination findings consistent with a diagnosis of periapical abscess were randomized to receive oral dexamethasone or an identical placebo. Pain was assessed using the verbal numeric scale in person at discharge and via telephone at 12, 24, 48, and 72 h after discharge from the ED.Results: Seventy-three patients were enrolled, with 37 receiving dexamethasone and 36 receiving placebo. Follow-up pain scores were obtained for 52 patients at 12, 24, 48, and 72 h. Ten patients from the dexamethasone group and 11 from placebo group were lost to follow-up. Patients who received dexamethasone reported a greater reduction in pain at 12 h compared with the placebo group (p = 0.029). Changes in pain scores from baseline and at 24, 48, and 72 h were not statistically significant. No adverse events were reported.Conclusions: Single-dose dexamethasone as adjunct to conventional medical management for pain caused by periapical abscess demonstrated a significant reduction in pain 12 h post treatment compared with placebo. [ABSTRACT FROM AUTHOR]

In spite of the development of modern injection techniques, palatal injection is still a painful experience for patients. A plethora of techniques has been tested to reduce this. One such technique that has been claimed to work is administering articaine on the buccal side alone for the extraction of maxillary teeth due to its ability to diffuse through soft and hard tissues more reliably than other local anaesthetics. This split mouth study evaluated the efficacy of 4% articaine with 1:100000 adrenaline to avoid the painful palatal injection for bilateral permanent maxillary tooth extraction in 50 patients. The 100mm 10 point Visual Analog Scale/Wong Baker Facial Pain Scale was used to rate the amount of pain felt on injection, on probing the tissues prior to, or during, extraction, and one hour postoperatively. Although the buccal injection alone resulted in lower pain while injecting the anaesthetic, it did not result in the absence of pain before tooth extraction as has been suggested by various studies. A total of 74% patients required a palatal injection on the study side. We conclude that in most cases, when using a buccal injection alone, one cannot rely on the diffusion of articaine for effective palatal anaesthesia. Despite this, we suggest that as an initial option in young patients, the operator can consider avoiding the painful palatal injection by the use of articaine to prevent aversion to dental treatment. Postoperatively, the difference in pain levels was not statistically significant and no patient showed signs of lesions at the injection sites. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the effectiveness of an electronic hand-held pulsed vibration device on the pain of local analgesia (LA) injection and physiologic changes. A prospective randomized controlled clinical trial using split-mouth (crossover) design was implemented. The control-side injection was performed after using topical anaesthesia. The experimental side injection was carried out without topical anaesthesia, but with the aid of a switched-on vibration device. Overall, 332 dental LA injections were given to 166 patients for routine exodontia. The pain at penetration and pain during injection were significantly lower in the experimental sides (vibrations sides) compared with those of the controls (P < 0.001). Similarly, the heart rate changes at penetration and during injections were significantly lower in the experimental sides (P < 0.001). The vibration device was clinically and statistically more effective than topical anaesthesia in the reduction of dental injection pain in adults, measured subjectively and objectively, regardless of the gender, injection technique (infiltration or block) or anxiety level. [ABSTRACT FROM AUTHOR]

Pain is a common symptom in endodontic conditions, but differential diagnostic procedures are often needed to exclude other pain origins. Thus, general dentists and endodontists need to be aware of alternative painful orofacial conditions and be able to identify them. The new International Classification of Orofacial Pain (ICOP) is the first comprehensive classification that uniquely deals with orofacial pain. The ICOP is a hierarchical classification modeled on the International Classification of Headache Disorders and covers pain in dentoalveolar and anatomically related tissues, muscle pain, temporomandibular joint pain, neuropathic pain affecting cranial nerves, pain resembling primary headaches, and idiopathic pain in the orofacial region. A description of each condition is given, and structured diagnostic criteria for each condition are proposed based on research data when available. This narrative review aims (1) to give an overview and brief explanation of the ICOP system, (2) to describe and give examples of how it can be of use to general dentists and endodontists with special attention to differential diagnosis of tooth pain, and (3) to highlight how endodontic research can contribute to validation and improvement of the classification. A comparison to other classification and diagnostic systems is also included. [ABSTRACT FROM AUTHOR]

This longitudinal study compared functional, anatomical, and quality of life (QoL) outcomes after closed reduction (CR) versus open reduction and internal fixation (ORIF) of condylar head fractures (CHFs). The aim was to determine predictability of results and to establish prognostic factors for poor outcomes, thus allowing therapeutic decision making between CR and ORIF. All fractures of the non-surgical group were treated by CR with maxillomandibular fixation (CR-MMF) according to an managed analogically. Morphological and functional results were acquired using axiography and clinical functional diagnostics, as well as MRI in problematic cases. Outcomes were compared with those of a collective of patients treated by ORIF with small fragment screws (SFS), according to a uniform standard. A total of 26 patients with 29 unilateral and bilateral CHFs of the non-surgical group were examined over a period of 28.5 months after completion of therapy and compared with a collective of 54 patients with 73 CHFs treated by ORIF. Statistically significant differences were found between both groups in protrusion and mediotrusion on the fracture side, in favour of ORIF. Significantly more patients in the ORIF group were symptom free in terms of the Helkimo dysfunction index and the RDC TMD compared with conservatively treated patients. Associations between Angle class and Helkimo dysfunction index, and between occlusion or number of teeth and pain after CT, could be confirmed. Given their respective indications, both treatment options demonstrated acceptable results in the majority of cases. However, for therapeutic decision making, it is crucial that the long-term results after CR are significantly less predictable. Our study showed only few positive prognostic factors for a stable functional outcome after CR such as isolated CHFs with stable occlusal conditions in younger patients (<25 years). [ABSTRACT FROM AUTHOR]

Introduction: The DSM-5 explicitly states that the neural system model of specific phobia is centered on the amygdala. However, this hypothesis is predominantly supported by human studies on animal phobia, whereas visual cuing of other specific phobias, such as dental fear, do not consistently show amygdala activation. Considering that fear of anticipated pain is one of the best predictors of dental phobia, the current study investigated neural and autonomic activity of pain anticipation in individuals varying in the degree of fear of dental pain.Method: Functional brain activity (fMRI) was measured in women (n = 31) selected to vary in the degree of self-reported fear of dental pain when under the threat of shock, in which one color signaled the possibility of receiving a painful electric shock and another color signaled safety.Results: Enhanced functional activity during threat, compared to safety, was found in regions including anterior insula and anterior/mid cingulate cortex. Importantly, threat reactivity in the anterior insula increased as reported fear of pain increased and further predicted skin conductance changes during pain anticipation.Limitations: The sample was comprised of women.Conclusions: Individual differences in fear of pain vary with activation in the anterior insula, rather than with the amygdala, indicating that fear is not uniquely associated with amygdala activation. Whereas coping techniques such as emotion regulation have been found to vary with activation in a frontal-amygdala circuit when confronted with visual cues, precision psychiatry may need to target specific brain circuits to diagnose and treat different types of specific phobia. [ABSTRACT FROM AUTHOR]

Temporal tendonitis (TT) is an orofacial pain disorder that can refer pain to the maxillary and mandibular molars, temporomandibular joint, masticatory muscles, eye, or ear. Patients often present to a dentist or physician with complaints reflecting these referral patterns, yet many healthcare providers are unfamiliar with TT because of the scarcity of literature published on this clinical entity. This may lead to diagnostic confusion, iatrogenic harm, and prolonged patient suffering. This case report describes TT that presented as maxillary and mandibular posterior tooth pain, preauricular pain, and decreased mandibular range of motion. Patient history and examination were suggestive of TT. Local anesthetic injection adjacent to the tendon eliminated all pain complaints and improved range of motion. The patient was given education on the condition and self-care instructions. At 1-week follow-up, the patient reported resolution of her pain complaint. As healthcare providers familiarize themselves with appropriate diagnostic and treatment options for TT, delayed or unnecessary care can be avoided, and proper management strategies can be implemented. [ABSTRACT FROM AUTHOR]

This case-control study aimed to compare trigeminal somatosensory sensitivity between patients with a clinical diagnosis of symptomatic irreversible pulpitis (n = 33) and healthy participants (n = 33) and to evaluate the impact of somatosensory stratification of symptomatic irreversible pulpitis on pulp sensibility testing. A standardized battery of qualitative sensory assessment measured intra- and extraoral sensitivity to touch, cold, and pinprick stimuli. Dental pain intensity (0–100, numeric rating scale) and duration (seconds) evoked by cold stimuli (refrigerant spray) were applied to, respectively, the nonaffected and affected tooth (cases) and the upper right and left premolars (controls); z score transformation, analysis of variance (ANOVA), and chi-square tests were applied to the data (P =.050). Patients with irreversible pulpitis reported intraoral hypersensitivity more frequently than healthy participants (58% and 33%, respectively; P <.05). In addition, patients with irreversible pulpitis reported higher z scores of pain intensity (ANOVA main effects, F = 37.10, P <.05, partial η2 = 0.37) and duration (ANOVA main effects F = 23.3, P <.05, partial η2 = 0.27) after the pulp sensibility test compared with healthy participants. Nevertheless, subgroup analysis taking into account the presence of intraoral hypersensitivity indicated that the pain lingered most for patients with symptomatic irreversible pulpitis who also presented intraoral hypersensitivity (Tukey test, P <.05) but with no differences between patients with irreversible pulpitis without intraoral hypersensitivity and healthy participants (Tukey test, P >.05). QualST is able to detect intraoral alterations in patients with symptomatic irreversible pulpitis that seem useful to stratify the patients into distinct subgroups. Therefore, somatosensory assessment of the adjacent tissues may provide diagnostic fine-tuning of dental pulp diseases. [ABSTRACT FROM AUTHOR]

Odontogenic infections can become life-threatening if not managed in a timely manner, and they increase the physical cost of treatment to the patient and the financial cost to the public health system. We investigated the number of admissions to a Queensland tertiary hospital within a decade, and differences in the patients' characteristics, severity at presentation, and clinical outcomes. We compared patients with odontogenic infections who were taken to theatre at the Royal Brisbane & Women's Hospital (RBWH) between January 2003 and December 2004 with those treated between January 2013 and December 2014, a total of 292. Data on demographics, presentation, previous history, antimicrobial treatment, and admissions, were collated and analysed. There were no significant differences in demographics. In the 2013/2014 group there was a two-fold increase in infections related to lower third molars (p = 0.001), a 50% increase in trismus (p = 0.001), and a 20% increase in submandibular swelling (p = 0.010). The percentage of patients admitted to the intensive care unit (ICU) was three and a half times higher in the 2013/2014 group (p = 0.001). The presentation of odontogenic infections has increased in the decade from 2003/2004 to 2013/2014. Measures of the severity of disease have increased, while the basic characteristics of the patients have remained constant. Improved primary preventative measures and early interventions are therefore needed to alleviate the burden that these infections place on the public health system. [ABSTRACT FROM AUTHOR]

The aim of the study was to assess the healthy migrant effect in relation to oral health among adults in England. This is a secondary data analysis of a nationally representative survey. Data from 13,373 adults of Irish, black Caribbean, Indian, Pakistani, Bangladeshi and Chinese ethnicity, who participated in the Health Survey for England, were analysed. The proportions of edentate and dentate adults with toothache in the last 6 months in first- and second-generation migrants within each ethnic group were compared with those in the white British (reference group) ethnic group in logistic regression models after adjusting for demographic factors and socio-economic position. Among first-generation migrants, the associations of age at arrival and length of residence with each oral health outcome were assessed in logistic regression models after adjusting for sociodemographic factors. Compared with white British migrants, first-generation black Caribbean (odds ratio [OR]: 1.42) and second-generation Pakistani (OR: 3.16) migrants had higher odds of being edentulous, whereas first-generation Indian (OR: 0.62), Pakistani (OR: 0.62), Bangladeshi (OR: 0.41) and Chinese (OR: 0.49) migrants had lower odds. Among dentate adults, second-generation Irish (OR: 1.51) migrants, first- and second-generation black Caribbean (OR: 1.61 and 1.54, respectively) migrants, first-generation Indian (OR: 1.24) migrants and second-generation Pakistani (OR: 1.34) migrants had higher odds of having toothache in the past 6 months, whereas second-generation Bangladeshi (OR: 0.51) migrants had lower odds than white British. Age at arrival and length of residence were positively associated with being edentulous among first-generation black Caribbean, Pakistani and Bangladeshi migrants. Evidence on the healthy migrant effect was mixed, with more consistent findings seen for edentulousness among Asian groups. Black Caribbean migrants were generally the ethnic group with the worst oral health when compared with white British. • Evidence on the healthy migrant effect (HMI) was mixed. • Consistent findings on HMI were seen for edentulousness among the Asian groups. • Black Caribbean migrants had worst oral health when compared with white British migrants. [ABSTRACT FROM AUTHOR]

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used to relieve various symptoms such as headache, arthralgia, and dental pain. While the primary mechanism of NSAID-based pain relief is the inhibition of cyclooxygenase-2, several NSAIDs also modulate other molecular targets related to nociceptive transmission such as voltage-gated Na+ channels. In the present study, we examined the effects of NSAIDs on persistent Na+ current (I NaP) mediated by tetrodotoxin-resistant (TTX-R) Na+ channels in small-to medium-sized trigeminal ganglion neurons using a whole-cell patch-clamp technique. At clinically relevant concentrations, all propionic acid derivatives tested (ibuprofen, naproxen, fenoprofen, and flurbiprofen) preferentially inhibited the TTX-R I NaP. The inhibition was more potent at acidic extracellular pH (pH 6.5) than at normal pH (pH 7.4). Other NSAIDs, such as ketorolac, piroxicam, and aspirin, had a negligible effect on the TTX-R I NaP. Ibuprofen both accelerated the onset of inactivation and retarded the recovery from inactivation of TTX-R Na+ channels at acidic extracellular pH. However, all NSAIDs tested in this study had minor effects on voltage-gated K+ currents, as well as hyperpolarization-activated and cyclic nucleotide-gated cation currents, at both acidic and normal extracellular pH. Under current-clamp conditions, ibuprofen decreased the number of action potentials elicited by depolarizing current stimuli at acidic (pH 6.5) extracellular pH. Considering that extracellular pH falls as low as 5.5 in inflamed tissues, TTX-R I NaP inhibition could be a mechanism by which ibuprofen and propionic acid derivative NSAIDs modulate inflammatory pain. [ABSTRACT FROM AUTHOR]

Dentists and physicians alike often prescribe opioids for dental pain management. The purpose of this study was to identify the common practices among United States endodontists for prescribing opioids to their patients. A descriptive, cross-sectional survey was developed to query 1000 American Association of Endodontists members from all 7 districts in the United States. The 20-question survey addressed provider demographics, types and frequency of medications prescribed, and clinical scenarios that compelled prescription-writing habits. The anonymous survey was electronically mailed. There was a preference to prescribe nonsteroidal anti-inflammatory drugs and/or acetaminophen followed by hydrocodone to manage endodontic pain. The majority of respondents limited an opioid prescription to ≤4 days. Different demographics played a role in the response to direct questions if they ever felt or succumbed to pressure toward prescribing opioids. Opioids are the second most prescribed medication to manage endodontic postoperative pain. Practice background was a significant factor in feeling pressure to prescribe an opioid. [ABSTRACT FROM AUTHOR]

• To analyze the tooth decay and acid erosion from European teeth biomedical data. • To collect information from children having age 5. • The teeth decay activities are monitored by EMOCA algorithm with RTRFNN. • To analyze the changes & characteristics of children biomedical teeth data. Now-a-days most of the children faced tooth decay and acid erosion problem in their teeth because of continuous bacterial infection, acid segregation, presents of food particles in teeth and so on. Especially, children are more affected by tooth decay, that leads to create severe problem like gingivitis, teeth loss and teeth pain. Due to the importance of tooth decay it needs to predict in earlier condition for eliminating children teeth problem such anorexia and bulimia disorders. Hence the bacterial infection of teeth is critical to be predicted from affected teeth. So, in this paper we analyze the tooth decay and acid erosion from European teeth biomedical data portal which collects information from children having age 5. The teeth decay activities are monitored by evolutionary multi-objective cuckoo feature selection (EMOCA) algorithm with Ruzzo–Tompa optimized regulatory feedback neural network (RTRFNN) that successfully analyze the changes and characteristics of children teeth biomedical teeth data. The introduced method effectively evaluates children tooth data before making the final decision about tooth decay and acid erosion. Then the excellence of the system is evaluated with the help of the experimental results, Ruzzo–Tompa optimized regulatory feedback neural network recognize the abnormal dental features with 99.22% of accuracy. [ABSTRACT FROM AUTHOR]

• Bite force is a viable and reliable objective index for the evaluation of orthodontic pain. • Periodontal administrations of NGF could completely mimic orthodontic pain. • Periodontal administrations of NGF neutralizing antibody could completely abolish orthodontic pain. • Periodontal injections of CFA could reduce bite force in rats. To examine the reliability of bite force for evaluating orthodontic tooth movement-induced pain in rats. Orthodontic tooth movement-induced pain was induced by mounting springs (40 g) between incisors and ipsilateral molars in male Sprague-Dawley rats. Five group sets of animals were used: for the first group set, 20 rats were randomly divided into a force group (n = 10) and a sham group (n = 10); for the second group set, 20 rats were divided into a 20-g group and a 80-g group; for the third group set, 20 rats were randomly divided into either a CFA group (complete freund's adjuvant) (n = 10) receiving periodontal injections of CFA at baseline or a control group (n = 10) receiving periodontal injections of saline at baseline; for the forth group set, 24 rats were randomly divided into the following four groups: force + saline, control + saline, force + antiNGF and control + NGF (NGF: nerve growth factor). Rats in the fifth group set were used for immunostaining against CGRP. Bite force and bite frequency were measured at baseline (day 0) and following interventions (day 1, day 3, day 5, day 7 and day 14). Two-way ANOVA with repeated measures was used for statistical analysis and a p value less than 0.05 was considered statistical significance. Our results revealed that bite force was significantly smaller in the force group than in the sham group at all time points (p <.001). As compared to the control group, periodontal injections of CFA significantly decreased bite force on the 3rd day (p <.01). Moreover, bite force was significantly higher in the force + antiNGF group than in the force + saline group (p =.01 <.05) while significantly smaller in the control + NGF group than in the control + saline group (p <.05). Bite force was similar between the force + antiNGF group and the control + saline group (p =.71 >.05) and between the control + NGF group and the force + saline group (p =.58 >.05). Similar results were found for bite frequency. [ABSTRACT FROM AUTHOR]

Abstract Introduction Regenerative endodontic procedures have emerged as a new treatment. The aim of this case report was to describe a regenerative autologous cellular therapy using mesenchymal stem cells from inflamed dental pulp and leukocyte platelet-rich fibrin (L-PRF) in a mature tooth. Methods A healthy 50-year-old man consulting for spontaneous dental pain was referred for endodontic treatment in tooth #28, which was diagnosed with symptomatic irreversible pulpitis. Inflamed dental pulp was extracted and transported to a good manufacturing practice laboratory for the isolation and culture of dental pulp stem cells (DPSCs). L-PRF was obtained from the patient's blood and was introduced into the instrumented and disinfected root canal, and expanded DPSCs were inoculated into the clot. The cervical part of the root canal was sealed with Biodentine (Septodont, Saint-Maur-des-Fosses, France) and a composite resin. Results Follow-up examinations were performed 6 months and 3 years later. The examinations included periapical radiographs (to measure the periapical index [PAI]), cone-beam computed tomographic (CBCT) imaging, sensitivity, and vitality tests. Clinical evaluations revealed normal responses to percussion and palpation tests. The tooth had a delayed response to cold, and the electric pulp test was responsive. The PAI and CBCT imaging revealed that the periapical area remained normal with a PAI score of 1 and a CBCT PAI score of 0. The vitality test performed indicated low blood perfusion units. Conclusions This case study reveals the potential use of a patient's own DPSCs and L-PRF as an alternative procedure for the treatment of pulpitis in mature permanent teeth. It also paves the way for the design of personalized cell-based clinical trials in regenerative endodontics. [ABSTRACT FROM AUTHOR]

Aging is related to a variety of physiological organ changes, including central and peripheral nervous systems. It has been reported that the orexin signaling has a potential analgesic effect in different models of pain, especially inflammatory pulpal pain. However, the age-induced alteration in dental pain perception and orexin analgesia has not yet been fully elucidated. Here, we tested that how aging may change the effect of orexin-A on nociceptive behaviors in a rat dental pulp pain model. The expression levels of orexin receptors and the nociceptive neuropeptides substance P (SP) and calcitonin-related gene peptide (CGRP) were also assessed in the trigeminal nucleus caudalis (TNC) of young and aged rats. Dental pulp pain was induced by intradental application of capsaicin (100 μg). The immunofluorescence technique was used to evaluate the expression levels. The results show less efficiency of orexin-A to ameliorate pain perception in aged rats as compared to young rats. In addition, a significant decrease in the number of orexin 1 and 2 receptors was observed in the TNC of aged as compared to young rats. Dental pain-induced SP and CGRP overexpression was also significantly inhibited by orexin-A injection into the TNC of young animals. In contrast, orexin-A could not produce such effects in the aged animals. In conclusion, the older age-related reduction of the antinociceptive effect of orexin may be due to the downregulation of its receptors and inability of orexin signaling to inhibit the expression of nociceptive neuropeptides such as SP and CGRP in aged rats. • The influence of age on dental pain perception and the efficacy of orexinergic system are not fully understood. • Orexin-A has less efficiency to ameliorate dental pain perception in aged rats as compared to young rats. • Aging caused a significant decrease in the number of orexin 1 and 2 receptors in the TNC of rats. • Dental pain-induced SP and CGRP overexpression was not inhibited by orexin-A. • Orexin receptors downregulation and its inability to inhibit nociceptive neuropeptides can be considered as aging problem. [ABSTRACT FROM AUTHOR]

This report documents the case of a patient who developed neuropathy that presented as dental pain and was later diagnosed with Lyme disease. A healthy female patient presented to the endodontist with toothache symptoms. Her symptoms included intense pain in the left mandible irradiating into the temporalis area and through her neck and tingling on the lower left lip and left side of her tongue. She also reported feeling of sweats and chills the night before, as well as an altered sensation in her shoulder and arm. The pain was not alleviated by over-the-counter analgesics. Both intraoral and radiographic examinations did not reveal any abnormalities, and the patient was presented with the following differential diagnoses: cardiac issues, trigeminal neuralgia, and temporomandibular dysfunction. She presented to the emergency department at the local hospital for assessment on the same day. After some tests were performed, both a stroke and myocardial infarction were ruled out. The following morning, she noticed a bump in the posterior area of her left upper thigh where an erythema with a bull's-eye appearance was observed. She presented to her family doctor's office on the same day and was diagnosed with Lyme disease. Because Lyme disease can present with symptoms similar to a toothache, dentists should be knowledgeable of its manifestations. Lyme disease should be considered as differential diagnosis in patients who present with compatible symptoms and signs, which may occur in the orofacial region. [ABSTRACT FROM AUTHOR]

Abstract This article describes an endodontic treatment technique performed through a new minimally invasive approach that leads to no tooth damage at the incisal edge and uses cone-beam computed tomographic (CBCT) imaging and 3-dimensional guides. A 26-year-old patient presented with pain in the anterior region of the maxilla and reported having suffered dental trauma 13 years prior. Radiographic examination exhibited no visible root canal on tooth # 9 with a slight thickening in the apical periodontal ligament space. Pulp sensitivity tests produced no response, whereas the percussion test responded positively. CBCT imaging revealed a visible canal space limited to the apical 2-mm section of the root. Guided endodontic access was planned after intraoral scanning of the tooth surface to be used with the CBCT scan. A virtual model was created with the aid of virtual implant software for the surgical access planning in such a way as not to damage the incisal edge of the tooth. The resulting guides were printed. With guides in position over the rubber dam, a mechanical-chemical preparation was performed in the root as soon as the canal was located. Intracanal medication was left for 14 days, after which the root canal was filled gutta-percha and the access cavity sealed. Follow-up was performed 1 year after completion of the treatment. The patient was asymptomatic with periapical tissue within normal limits. The guided endodontic therapy optimized the treatment, having provided a conservative access with no tooth damage at the incisal edge in a safe and predictable way despite the presence of a severely calcified root canal. [ABSTRACT FROM AUTHOR]

Introduction Recent studies have investigated the relationship between pain perception and specific phenotypes such as red hair color and various eye colors. Further investigations into biomarkers as they relate to pain could be useful in understanding underlying genetic components involved in these pathways. Additionally, it would be clinically useful to determine if a patient would be more likely to experience pain during dental treatment based on eye color. The purpose of this study was to investigate a link between eye color and perceived injection pain in healthy, asymptomatic white women. Methods Three hundred healthy, adult, white female patients were included, 133 with dark eyes and 167 with light eyes. Dental anxiety was assessed with the Corah Dental Anxiety Scale. Subjects with their eye color masked by dark glasses received a right maxillary lateral incisor infiltration of 1 cartridge of 2% lidocaine with 1:100,000 epinephrine. Patients rated their injection pain on a 170-mm Heft-Parker visual analog scale. Photographs of the subjects' eyes were taken after the infiltrations and categorized into dark- and light-eyed groups by 3 independent observers. Comparisons for injection pain were analyzed using analysis of variance and the Tukey-Kramer test. Results No significant differences were found for pain of injection between dark- or light-eyed subjects. Conclusions Eye color was not shown to be a predictor for injection pain in white women. Therefore, eye color would not be clinically useful in determining if a patient would be more likely to experience pain during dental treatment. [ABSTRACT FROM AUTHOR]

Introduction Persistent dentoalveolar pain of idiopathic origin represents a diagnostic challenge for the dentist and physician alike. Disagreement on taxonomy and diagnostic criteria presents a significant limit to the advancement of research in the field. Patients struggle with a lack of knowledge by dental and medical professionals, diagnostic delays, and unnecessary treatments. Methods A PubMed search was performed as of January 1, 2017 by using the terms atypical odontalgia, phantom tooth pain, persistent idiopathic facial pain, painful posttraumatic trigeminal neuropathy, idiopathic toothache, persistent dentoalveolar pain disorder, nonodontogenic tooth pain, and continuous neuropathic orofacial pain. Three hundred forty-five abstracts were screened, and 128 articles that were pertinent to the topic went through full-text reading. Results Case reports and narrative reviews constitute the majority of available literature. Several retrospective case-control studies investigated the clinical characteristics, pathophysiology, and diagnostic processes. Treatment strategies were evaluated in only 7 open-label and 2 randomized controlled trials. Conclusions Persistent dentoalveolar pain disorder is likely neuropathic in origin, but pathophysiological mechanisms to explain the onset and persistence of the pain are still far from understood. A correct diagnosis should be established before treatments are performed. Researchers should reach an agreement on the diagnostic criteria to enable a coherent research path to better understand the condition and reduce patient suffering. [ABSTRACT FROM AUTHOR]

Objective: Atypical Odontalgia (AO) is a condition characterized by tooth pain with no apparent cause. Although psychiatric comorbidity seems to be very common, it has rarely been studied. To clarify the influence of psychiatric comorbidity on the clinical features in patients with AO, we retrospectively evaluated their examination records.Methods: Clinical features and psychiatric diagnoses of 383 patients with AO were investigated by reviewing patients' medical records and referral letters. Psychiatric diagnoses were categorized according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). We also analyzed visual analogue scale (VAS), self-rating depression scale (SDS), and the short-form McGill pain questionnaire (SF-MPQ) scores.Results: Of the 383 patients with AO, 177 (46.2%) had comorbid psychiatric disorders. The most common were depressive disorders (15.4%) and anxiety disorders (10.1%). Serious psychotic disorders such as bipolar disorder (3.0%) and schizophrenia (1.8%) were rare. Dental trigger of AO was reported in 217 (56.7%) patients. There were no significant correlations between psychiatric comorbidities and most of the demographic features. Higher VAS and SDS scores, higher frequency of sleep disturbance, and higher ratings of "Fearful" and "Punishing-cruel" descriptors of the SF-MPQ were found in patients with psychiatric comorbidity.Conclusions: About half of AO patients had comorbid psychiatric disorders. Dental procedures are not necessarily causative factors of AO. In AO patients with comorbid psychiatric disorders, pain might have a larger emotional component than a sensory one. VAS, SDS, and SF-MPQ scores might aid in the noticing of underlying comorbid psychiatric disorders in AO patients. [ABSTRACT FROM AUTHOR]

The primary source of facial mucormycosis is through inhalation of fungal sporangiospores, resulting in invasive disease in paranasal sinuses. However, dental onset mucormycosis has not been well documented in literature. The aim of this study was to describe the clinical characteristics and outcomes of patients with odontogenic onset mucormycosis. From a large cohort of mucormycosis involving the face between July 2020 and October 2021, we selected patients who had dental symptoms at onset and predominant alveolar involvement with little to no paranasal sinus disease as shown by baseline imaging. All patients had a confirmed diagnosis of mucormycosis through histopathology, with or without the growth of Mucorales in fungal culture. Out of 256 patients with invasive mucormycosis of the face, 8.2% (21 patients) had odontogenic onset. Uncontrolled diabetes was a common risk factor, affecting 71.4% (15/21) of the patients, while recent COVID-19 illness was noted in 80.9% (17/21) of patients. The median duration of symptoms at presentation was 37 days (IQR, 14–80 days). The most common symptoms were dental pain with loose teeth (100%), facial swelling (66.7% [14/21]), pus discharge (28.6% [6/21]), and gingival and palatal abscess (28.6% [6/21]). Extensive osteomyelitis was found in 61.9% (13/21) of the patients, and 28.6% (6/21) had oroantral fistulas. The mortality rate was low, at 9.5% (2/21), with only 9.5% (2/21) of the patients having brain extension and 14.2% (3/21) in the orbit. This study suggests that odontogenic onset invasive mucormycosis may be a separate clinical entity with its own distinct clinical features and prognosis. [ABSTRACT FROM AUTHOR]

Introduction Pain felt during dental injections is dependent on dental anxiety. Patients feel increased pain if anxiety in the treatment environment is high, and therefore it is important to reduce anxiety during treatment to reduce pain. The purpose of this study was to compare pain and anxiety levels experienced during injections using a newly invented telescopic-coated dental needle that covers the conventional needle and also has the capability of applying topical anesthesia through its unique design with the conventional dental injection needle. Methods Dental injection anxiety questionnaires were completed by 60 adult patients who were randomly assigned to either the telescopic (a newly invented telescopic-coated dental needle that covers the needles) or the conventional group. Patients also completed visual analog scales to rate their pain perception during injection, their overall experience, and their future anticipated anxiety. Wilcoxon, Mann-Whitney, and Student t tests were used for statistical analysis. Statistical significance was defined as P < .05. Results A total of 25 men and 35 women with an age range of 19–55 years (mean age of 38.7 ± 2.31 years) participated in this study. Pain levels reported during the injection using the telescopic-coated needle (4.13 ± 1.37) were significantly lower than those using the conventional needle (5.63 ± 1.57), with statistically significant differences between the 2 groups ( P < .05). Patients experienced significantly lower overall postinjection anxiety ( P < .05) and had more positive overall experience ratings with the telescopic-coated needles. Conclusions A new telescopic-coated dental needle was superior to a conventional injection system in pain perception and in reducing postinjection dental anxiety. [ABSTRACT FROM AUTHOR]

Painful trigeminal neuropathy attributed to a space-occupying lesion (code 13.1.2.5 in the International Classification of Headache Disorders, 3rd edition [beta version]) is an orofacial pain condition that has characteristics of classical trigeminal neuralgia but is caused by a space-occupying lesion. We present 4 cases of intracranial lesions mimicking odontogenic pain as follows: case 1, a 61-year-old woman presented with a chief complaint of aching soreness in the right mandibular molar area for 1 year; case 2, a 59-year-old man presented with severe pain in the left maxillary and mandibular molars; case 3, a 72-year-old man presented with a chief complaint of facial shock–like pain on the left side; and case 4, a 75-year-old man presented with a chief complaint of paroxysmal pain and numbness in the buccal gingiva of the right mandibular molar region. Cases 1 and 2 had trigeminal neuralgia, which had previously been incorrectly attributed to osteoma and maxillary sinus retention cyst, respectively, and resulted in inappropriate dental surgical procedures. All patients subsequently underwent magnetic resonance imaging, and the results were consistent with intracranial disease. Magnetic resonance images revealed acoustic neuromas in the cerebellopontine angle in cases 1, 2, and 4 and a small meningioma near the entry to the left Meckel cave in case 3. Cases 1, 3, and 4 had these lesions removed; after which, their pain resolved. Before dental treatment, dental practitioners should focus not only on dental imaging but also on the patient's medical history and pain characteristics. [ABSTRACT FROM AUTHOR]

Introduction Information on the nerve fibers innervating the dental pulp is crucial for understanding dental pain and hypersensitivity. This study investigated the morphologic differences of parvalbumin (PV)-positive (+) myelinated fibers in 3 different regions of the human dental pulp. Methods Light and electron microscopic immunohistochemistry for parvalbumin, a marker for myelinated fibers, and quantitative analysis were performed in the apical root, core of coronal pulp, and peripheral pulp of human premolar teeth. Results About 40% of the myelinated fibers in the apical root pulp became unmyelinated in the core of the coronal pulp, and virtually all the remaining fibers became unmyelinated at the peripheral pulp. The size of myelinated axons decreased from root to peripheral pulp. PV+ axons showed extensive axonal varicosities in the peripheral pulp. Conclusions These findings suggest that the myelinated fibers innervating the human dental pulp undergo extensive morphologic change in the extrapulpal region and in the coronal and peripheral pulp, and that PV-mediated regulation of calcium concentration and its downstream events may occur primarily in axonal varicosities in the peripheral pulp. [ABSTRACT FROM AUTHOR]

Introduction The present clinical trial aimed to evaluate and compare the effect of a single pretreatment dose of ketorolac (20 mg), prednisolone (30 mg), and placebo on postendodontic pain in patients undergoing endodontic therapy for irreversible pulpitis or pulpal necrosis using a visual analog scale. Methods Ninety-two subjects were included in the present trial; 46 subjects had a pulpal diagnosis of irreversible pulpitis, and the other 46 had pulpal necrosis. These subjects were randomly allocated into 1 of the 3 pretreatment medication groups: ketorolac (20 mg), prednisolone (30 mg), or a placebo. The drugs were administered 30 minutes before the procedure followed by a routine single-visit root canal treatment. Preoperative and postoperative pain was evaluated using a visual analog scale at 6 time intervals. A comparison between the different groups was performed using one-way analysis of variance followed by the Tukey post hoc test. A comparison of pain within each group at various time intervals was performed using repeated measures analysis of variance followed by the paired t test and Bonferroni correction. Results At the end of 6 hours, in irreversible pulpitis cases, the ketorolac group showed an effective reduction in pain scores compared with the other drugs. At the end of 12 hours, the prednisolone group significantly reduced the pain scores compared with the other drugs. Conclusions From this study, it could be concluded that a single pretreatment dose of prednisolone has a more sustained effect in reducing postendodontic pain compared with placebo or ketorolac. [ABSTRACT FROM AUTHOR]

Ethnopharmacological relevance Hypericum perforatum L. (Hypericaceae), popularly called St. John's wort (SJW), has a rich historical background being one of the oldest used and most extensively investigated medicinal herbs. Many bioactivities and applications of SJW are listed in popular and in scientific literature, including antibacterial, antiviral, anti-inflammatory. In the last three decades many studies focused on the antidepressant activity of SJW extracts. However, several studies in recent years also described the antinociceptive and analgesic properties of SJW that validate the traditional uses of the plant in pain conditions. Aim of the review This review provides up-to-date information on the traditional uses, pre-clinical and clinical evidence on the pain relieving activity of SJW and its active ingredients, and focuses on the possible exploitation of this plant for the management of pain. Materials and methods Historical ethnobotanical publications from 1597 were reviewed for finding local and traditional uses. The relevant data on the preclinical and clinical effects of SJW were searched using various databases such as PubMed, Science Direct, Scopus, and Google Scholar. Plant taxonomy was validated by the database Plantlist.org. Results Preclinical animal studies demonstrated the ability of low doses of SJW dry extracts (0.3% hypericins; 3–5% hyperforins) to induce antinociception, to relieve from acute and chronic hyperalgesic states and to augment opioid analgesia. Clinical studies (homeopathic remedies, dry extracts) highlighted dental pain conditions as a promising SJW application. In vivo and in vitro studies showed that the main components responsible for the pain relieving activity are hyperforin and hypericin. SJW analgesia appears at low doses (5–100 mg/kg), minimizing the risk of herbal-drug interactions produced by hyperforin, a potent inducer of CYP enzymes. Conclusion Preclinical studies indicate a potential use of SJW in medical pain management. However, clinical research in this field is still scarce and the few studies available on chronic pain produced negative results. Prospective randomized controlled clinical trials performed at low doses are needed to validate its potential efficacy in humans. [ABSTRACT FROM AUTHOR]

Introduction We aimed to simultaneously investigate the effects of topical anesthesia on needle insertion and injection pain in the labial mucosa of the maxillary central incisors of patients awaiting apical surgery and to assess the relationship between patients' anxiety and pain scores. Methods Forty-four patients scheduled for apical surgery of the maxillary anterior incisor or canine were included, and all completed the Modified Dental Anxiety Scale (MDAS) questionnaire. One piece of Xylocaine (AstraZeneca, Sodertalje, Sweden) gauze was applied to the right or left side of the labial vestibule below the central incisor according to a randomization process, and 1 piece of water gauze was applied to the contralateral side of the labial vestibule. Each piece of gauze remained in place for 2 minutes. The subjects were asked to rate their pain according to the numeric rating scale immediately after needle insertion and anesthetic solution injection. Results Topical anesthetic application significantly reduced both insertion- and injection-related pain. Injection pain was significantly higher than insertion pain throughout the experiment. The difference in pain scores between the placebo and topical anesthetic groups was significantly greater for insertion pain than injection pain. The group with higher MDAS scores showed significantly higher pain scores, except for insertion pain reported by the topical anesthetic group, which did not show a significant difference between MDAS score groups. Conclusions The topical anesthetic was highly effective for both insertion and injection pain during infiltration anesthesia in the maxillary central incisors. Highly anxious patients reported higher pain scores; however, topical anesthetics reduced the effect of anxiety on increasing pain. [ABSTRACT FROM AUTHOR]

Ethnopharmacological relevance Weeds are plants grow naturally and are commonly seen. They are mostly used for feedstuff. However, their use as herbs for treating diseases, including gastrointestinal disorders, is rare. Therefore, the present study aimed to: (1) quantify the number of herbal weeds used for treating gastrointestinal disorders; (2) study local knowledge of weed utilization for treating gastrointestinal disorders in Songkhla and Krabi provinces; and (3) analyse quantitative data with the Informant Consensus Factor (ICF), Use Value (UV) and Fidelity Level (FL). Materials and methods The study was conducted from November 2014 to January 2016 through semi-structured interviews with 35 folk healers. The main questions were designed to obtain plant information, including the local name, method of use, preparation method and medicinal properties. The data were analysed by descriptive statistics, quantitative indexes (UV, ICF as well as FL) and interpretation. Results A total of 49 species in 46 genera and 28 families were found. The most common use of weeds was as herbs (80%). The preferred part used was the whole plant (76.27%). The preferred methods of drug preparation and use were decoction and drink, respectively. The highest UV was found for Acmella oleracea (0.83). The highest FLs (100%) were found for 12 species, including Amaranthus spinosus , Amaranthus viridis , Alternanthera sessilis , Sauropus androgynus , Plantago major, and others. The highest ICFs (1.00) were found for treating toothache, dysentery, haemorrhoids, intestinal pain and abdominal pain. Conclusion Overall, there are reports on the pharmacological activity of 31 species of weeds and reports on toxicity for 20 species of weeds. Therefore, awareness of the use of herbs is necessary to ensure that they are used safely and that benefits arise from the therapy. This study showed that medicinal weeds are still popularly used by folk healers. The pharmacological properties were consistent with the local uses, which supported a preliminary indication that the weed plants were effective for treating gastrointestinal diseases. [ABSTRACT FROM AUTHOR]

Introduction Two groups of patients with orofacial pains that are clinically important to distinguish from each other are patients with odontogenic pain and temporomandibular disorder (TMD) pain. The aim of this study was to determine the sensitivity and specificity of 2 screening instruments in distinguishing between patients with these types of pain. Methods A convenience sample of patients seeking care at an endodontic clinic and an orofacial pain clinic were recruited. The 14-item dental pain questionnaire (DePaQ) was used to screen for odontogenic pain and the 6-item TMD screener was used to screen for TMD pain. Sensitivity and specificity calculations with 95% confidence intervals (CIs) were performed for both instruments, and thresholds/acceptability/performance was assessed using published guidelines. Results Thirty-four patients with odontogenic pain and 37 patients with TMD pain were included in this study. The sensitivity of the DePaQ was 0.85 (95% CI, 0.69–0.95), and specificity was 0.11 (95% CI, 0.03–0.25). The sensitivity of the TMD screener was 0.92 (95% CI, 0.78–0.98), and specificity was 0.59 (95% CI, 0.41–0.75). The point estimates, a single value used to estimate the population parameter, for both the DePaQ and TMD screener were “acceptable” in identifying patients who had the pain condition in question (ie, sensitivity), whereas the point estimate for appropriately identifying patients who did not have the pain condition when they did not have it (ie, specificity) was “nonacceptable” for both. Conclusions The DePaQ and the TMD screener lack diagnostic accuracy for differentiating TMD from odontogenic tooth pain without adjunctive (clinical) investigation(s) or examination. However, the TMD screener has high sensitivity for identifying true positives (ie, TMD pain) and would therefore be useful as a screening instrument when one can definitively exclude odontogenic etiology for pain on clinical and radiographic grounds, for instance in endodontic practices. In this study, the negative predictive value was also high in the TMD screener, and, therefore, we can trust a negative result (ie, when the TMD screener is negative, we can be fairly certain the pain diagnosis is not TMD and rule out TMD). [ABSTRACT FROM AUTHOR]

Introduction Nonsteroidal anti-inflammatory drugs (NSAIDs) have been commonly used to treat endodontic postoperative pain. The purpose of this study was to address the following Population, Intervention, Comparator, Outcome, Timing, Study design and setting question: in patients with preoperative pain who undergo initial orthograde endodontic treatment, what is the comparative efficacy of NSAIDS compared with non-narcotic analgesics or placebo in reducing postoperative pain and the incidence of adverse events. Methods Ovid MEDLINE (1946–December 15, 2015), the Cochrane Database of Systematic Reviews (2005–December 15, 2015), and the Cochrane Central Register of Controlled Trials (to December 15, 2015) were searched using included drugs, indications, and study designs as search terms. Hand searches in texts were also conducted. Two independent reviewers assessed eligibility for inclusion, extracted data, and assessed quality using the risk of bias tool. L'Abbe plots were used for qualitative review. Where applicable, meta-analysis was conducted on the pooled effect size (ES). Results Two thousand two hundred eighty-four studies were identified through the database searches; 405 full-text articles were assessed. Fifteen articles met the inclusion criteria; qualitative analysis revealed all studies had a moderate to high risk of bias. Ibuprofen was the most studied NSAID. The L'Abbe plots showed that NSAIDS are effective at relieving postoperative endodontic pain overall. Meta-analysis showed that ibuprofen 600 mg is more effective than placebo at 6 hours postoperatively (ES = 10.50, P = .037), and ibuprofen 600 mg + acetaminophen 1000 mg combination is more effective than placebo (ES = 34.89, P = .000) but not significantly different than ibuprofen (ES = 13.94, P = .317). Five studies reported patients experiencing adverse events such as drowsiness, dizziness, nausea, and emesis; 2 studies reported that patients experienced no adverse events. Conclusions A combination of ibuprofen 600 mg and acetaminophen 1000 mg is more effective than placebo but not significantly different than ibuprofen 600 mg at 6 hours postoperatively. Ibuprofen 600 mg is more effective than placebo at 6 hours postoperatively; however, there are insufficient data to recommend the most effective NSAID, dose amount, or dose interval for the relief of postoperative endodontic pain of longer duration in patients with preoperative pain. [ABSTRACT FROM AUTHOR]

Control of pain, fear, and anxiety of children during dental procedures is a major challenge in pediatrics. This study aimed to compare the effect of audio distraction by music and audio-story on pain and anxiety of children during dental treatment. This randomized crossover clinical trial evaluated 60 systemically healthy children between 4 and 8 years, who were candidates for pulpotomy and steel crown of bilateral primary maxillary first or second molars. The patients were randomly divided into two groups of music-story (M first), and story-music (S first) according to the sequence of receipt of the distraction techniques with a split-mouth design. The level of pain and anxiety of patients was measured using physiological scales such as pulse rate (PR), sound-eye-motor (SEM) and faces pain rating (FPR). The pkcross package in Stata software version 14 was used to assess the treatment effect, period effect, sequence effect and carryover effect. In each group, 28 cases were included in the analysis. The difference in PR was not significant at the onset and termination of each treatment session between two distraction techniques and also, the mean FPR (P = 0.55) and SEM (P > 0.99) scores were not significantly different between the two groups. The "audio-story" and "music" distraction techniques were not significantly different for pediatrics relieving during LA administration. Thus, considering the equal efficacy of the two techniques, dental clinicians can use any of the two to distract children. The study registered in the Iranian Registry of Clinical Trials (IRCT20190702044077N1). • Dental fear and anxiety of children are among the most common problems encountered by the parents and dental clinicians, particularly pediatric dentists. • The distraction techniques such as audio-visual and audio techniques are often used to distract the child from the ongoing unpleasant treatment process. • Both audio story and music distraction techniques equally decreased the level of pain and anxiety of children. [ABSTRACT FROM AUTHOR]

Garcinia oligantha Merr. is an ethnomedicine plant mainly distributed in Guangdong and Hainan, China. It has the effects of heat-clearing and detoxicating, which has been used by local ethnic minorities to treat a variety of diseases, including inflammation, internal heat, toothache and scald. This review summarizes and discusses the progress of the chemical compounds and biological activities of G. oligantha that have been studied in recent years to provide the direction for the prospective research and applications of G. oligantha. The relevant literature about G. oligantha was accessible from ancient Chinese medical books and records, theses, as well as major scientific databases such as Google Scholar, PubMed, Web of Science, ScienceDirect, SciFinder, Baidu Scholar and China National Knowledge Infrastructure (CNKI). To date, more than 150 chemical compounds were isolated from this plant, including xanthones, volatile oil, fatty acid, benzofurane derivative and biphenyl compounds. Xanthones are the main bioactive compounds that exhibit diverse biological effects, such as antitumor, analgesic, anti-inflammatory, antioxidative, neuroprotective, antimalarial and antibacterial effects, which are consistent with its traditional uses as a folk medicine. Modern pharmacological studies show that these compounds participate in a variety of signaling pathways underlying different pathophysiologies, making them a valuable medicinal resource. G. oligantha is an ethnomedicine with a long history. However, due to regional and cultural constraints, the popularisation and use of ethnomedicine are still limited. Modern pharmacological and chemical research suggest that G. oligantha contains a variety of bioactive compounds and showed diverse biological functions, which is worthy of comprehensive and in-depth research. This review summarizes and discusses the recent progress in studies on G. oligantha , looking forward to promote further research and sustainable development of folk medicinal plants. [Display omitted] [ABSTRACT FROM AUTHOR]

Ethnopharmacological relevance In the study area, the traditional knowledge and cultural practices of utilizing medicinal plants in the human healthcare is primarily restricted to the old age members of the community, while younger generation is mostly unaware of the natural wealth usage. Aim of the study We provide the first ever ethno medicinal insights into the management of dental disorders in Pakistan. The prime objective of the study was to explore novel knowledge of these local and remote community members and share it with rest of the world in documented form. Materials and methods Field surveys were arranged for collection and documentation of medicinal plants of Manoor valley during 2015. Total 71 local inhabitants were interviewed randomly through questionnaire. The data obtained were quantitatively analyzed using the use value (UVi), relative frequency citations (RFCs), fidelity level index (FL%) and consensus index (CI%). For novel uses all plants were thoroughly checked with previously published articles on the same disorder and analyzed through Jaccard index (JI) and Sorensen's similarity index (QS). The collected specimens after confirmation were submitted to the Herbarium, Department of Botany, Hazara University, Mansehra, Pakistan (HUP). Results In present study 25 plants belonging to 17 families are reported, these plants were used commonly as ethno medicine. There were herbs (64%), shrubs (20%) and trees (16%) whereas, Lamiaceae with 4 species was the leading family. Majority of medicinal plant species were used in treatment of toothache (38%), wound healing (19%), gum infections (16%) whereas and lowest percentage of species were used for mouth ulcer as well as teeth powder (3%). Leaves were the most widely part used plant part in the treatment of different diseases (36%). Dominated medicinal plants with high used values were Juglans regia (UVi=0.94), Rumex dentatus (0.89) and Indigofera heterantha (0.88). Based on the RFC values, the most valuable and cited medicinal plant species used by the traditional drivers are Juglans regia having (RFCs=0.69) and Rumex dentatus (0.58). CI results show that most respondents percentage was for Juglans regia having CI%=69%, followed by Rumex dentatus (57.7%). Medicinal plants with high fidelity level and reported for one dental disorder were Berberis lycium, Geranium wallichianum, Lathyrus aphaca, Platanus orientalis, Sedum spp. and Urtica dioica for toothache. Further, new medicinal uses of Abies pindrow, Ajuga integrifolia, Berberis lycium, Urtica dioica , Indigofera heterantha were recorded for the first time from Pakistan and Astragalus grahamianus , Corydalis cornuta, Prunella vulgaris, Ranunculus muricatus, Rumex hastatus, Stellaria media, Tagetes minuta, Taraxacum officinale and Lathyrus aphaca, across the world for the current reported medicinal uses. All mentioned plant species are reported for the first time ever for dental disorders from Manoor Valley. Nonetheless, this is a novel study as no single ethno medicinal study on dental disorder up-till now has been reported from Pakistan. Conclusion The present study is the first ever documentation of ethno medicinal practices aiming at the dental disorders in Pakistan, which resulted in 64% of medicinal uses new claims. So, the reported species of remote valley should be further evaluated for proper experimentation and pharmacological activities to authenticate their current traditional usage. Field observation revealed vegetation of the area was generally threatened due to its unwise use by the local communities. Trends like deforestation, over grazing, habitat fragmentation and introduction of the exotic taxa were the visible threats. So conservation of such an important natural God gifted treasure is mandatory. [ABSTRACT FROM AUTHOR]

Preparations from the bark and leaves of Schinus terebinthifolia Raddi are commonly used to treat toothaches and sore throats. The use of medications based on leaves of this plant has also been reported for pain of arthritis, toothache, and sore throat. Some evidence indicated that the lectin SteLL is an antinociceptive agent from leaves. This study evaluated the antinociceptive activity of S. terebinthifolia leaf lectin (SteLL) using mouse models of peripheral and central nociception. Animals were treated intraperitoneally with SteLL at 1, 5, and 10 mg/kg. An acetic acid-induced abdominal writhing test was performed to screen for the antinociceptive effect of the lectin. Next, the formalin test was used to assess the effects of SteLL on neurogenic (first phase) and inflammatory (second phase) pain, as well as to investigate the involvement of the carbohydrate-recognition domain (CRD) of SteLL and opioid receptors in the antinociceptive effect. The tail immersion test was performed to assess the central antinociception. Additionally, a rotarod test was performed to evaluate the effects of lectin on motor coordination in mice. SteLL reduced the number of acetic acid-induced writhes by 83.5–100.0%. In the first phase of the formalin test, SteLL reduced paw licking time by 49.4–50.5%, while in the second phase, SteLL reduced paw licking time by 80.5–82.6%. This antinociceptive effect was reversed by the previous incubation of the lectin with ovalbumin (indicating the possible involvement of the CRD) and by the administration of naloxone, a nonselective opioid receptor antagonist. When testing selective antagonists of opioid receptors (μ, δ, and κ), only naltrindole, a selective δ receptor antagonist, blocked the antinociceptive action of SteLL during the second phase of the formalin test. In the tail immersion test, SteLL (1, 5, and 10 mg/kg) administration reduced sensitivity to thermal stimulus, which was observed even after 2 h. SteLL (10 mg/kg) did not affect animal motor coordination in rotarod test when compared to the control group. SteLL has peripheral and central analgesic action involving opioid receptor modulation without affecting the motor coordination of animals. These results provide new perspectives for developing analgesic agents using lectins. [Display omitted] • Antinociceptive activity of Schinus terebinthifolia leaf lectin (SteLL) was evaluated. • SteLL reduced the number of acetic acid-induced writhes by 83.5–100.0%. • SteLL reduced paw licking time by 80.5–82.6% in inflammatory phase of formalin test. • Antinociceptive effect involves carbohydrate-recognition domain of lectin and δ-opioid receptors. • SteLL also reduced sensitivity to thermal stimulus and did not affect the motor coordination of animals. [ABSTRACT FROM AUTHOR]