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Self-contained underwater breathing apparatus (SCUBA) diving is becoming widely democratized among hobbyist practitioners. It can cause orofacial problems, mostly linked to pressure changes. The aim of this study was to assess the prevalence of these problems and to analyze civilian divers' behavior about their dental prevention in France, via a cross-sectional study. Data from 1015 French civilian divers were collected via a nationwide online questionnaire in which participants indicated information concerning orofacial experienced problems during their diving activity, and their medical preventive habits. As results, oral manifestations were experienced by 25.2% of the divers, including barodontalgia (10.8%), mouth syndrome (13.4%), gum pain (2.8%) and dental fractures caused by barotrauma (3.7%) or shocks (1.9%). Mouth syndrome was more frequent among women (18.6%) and divers aged between 18 and 34 years (18.9%). The prevalence of dental fractures increased significantly with age. High diving level was associated with more frequent barodontalgia (17.5%), gum pain (7%) and barotrauma (7.6%). Among respondents, 43.5% completed a dental examination before a diving season and showed fewer oral problems during their scuba diving practice than those who did not. In conclusion, oral problems in scuba diving represent frequent events that can compromise the safety of divers. Despite awareness rising, there is a lack of recourse to the dentist. This leads to incomplete information, especially concerning the preventive means available to divers.

INTRODUCTION: Barometric pressure variation during dives may induce barodontalgia and barotrauma. Barodontalgia refers to oral pain resulting from a change in ambient pressure. The aim of this study was to investigate the occurrence of barodontalgia and dental barotrauma among French civilian scuba divers.METHODS: A nationwide cross-sectional internet-based survey was conducted among French scuba divers over 18 yr of age registered by the French Federation of Underwater Sports (FFESSM). The online questionnaire was distributed from October to December 2020. It contained questions regarding general characteristics of participants, barodontalgia and dental barotrauma occurrences, and relationship of the diver with his/her dentist.RESULTS: There were 684 scuba divers (65.4% men; aged 48 ± 12 yr) who participated in the study. Barodontalgia was reported by 18.7%, with some respondents reporting more than one episode. Most barodontalgia affected posterior (81.2%) and upper teeth (55.2%) with dental filling (50.0%). At least one dental barotrauma was reported by 10.1% of respondents, including mainly loss or fracture of a dental filling (4.2%). The occurrence of dental barotrauma was significantly higher among men (12.3%) than women (5.9%) and increased significantly with the age, the years of diving and the diving qualification.CONCLUSION: Information should be provided to divers on the importance of routine dental checkups.Gougeon K, Yasukawa K, Baudet A. Barodontalgia and dental barotrauma among scuba divers. Aerosp Med Hum Perform. 2022; 93(5):421–425.

Objectives To investigate the prevalence of toothache and its risk indicators in the older Chinese population. Methods National cross-sectional survey data on 25 048 Chinese people ≥65 years in 2011, 2014 and 2018 survey year were analysed and then pooled. Chi-square test was used to examine the differences in prevalence among specific subgroups. Multivariate modified Poisson regression analyses with robust error variances were used to detect related factors and prevalence ratios (PR) were calculated. Results The prevalence of toothache was 16.3% (95% CI: 15.5%-17.1%), 12.8% (95% CI: 12.0%-13.7%) and 16.0% (95% CI: 15.3%-16.7%) in years 2011, 2014 and 2018. In the pooled multivariate Poisson regression model, factors associated with toothache were female (PR: 1.27, 95% CI: 1.18-1.37), younger age (PR: 1.84, 95% CI: 1.63-2.09), currently married and living with spouse (PR: 1.08, 95% CI: 1.01-1.15), current living in urban area (PR:1.12, 95% CI: 1.06-1.20), enough financial support (PR: 0.69, 95% CI: 0.65-0.74), having chronic disease (PR: 1.46, 95% CI: 1.35, 1.57), higher sugar intake (PR: 1.10, 95% CI: 1.03-1.17), salty flavour (PR:1.15, 95% CI: 1.07-1.23), smoking (PR: 1.14, 95% CI:1.06-1.23) or drinking (PR: 1.17, 95% CI: 1.09-1.25), with denture (PR: 1.15, 95% CI: 1.08-1.22) and higher toothbrushing frequency (PR: 1.25-1.50). Conclusions More than one in ten older Chinese population had toothache, and it was related to age, gender, socioeconomic status, behaviour and oral health status. Lifestyle interventions should be taken to avoid the occurrence of the toothache.

Objective. In order to further study the changes of cerebral functional connectivity in patients with toothache (TA), this study used the resting-state functional magnetic resonance imaging (rs-fMRI) technique and degree centrality (DC) analysis method. Methods. Eighteen TA patients (8 males, 10 females) and 18 healthy individuals of similar age, sex, and educational levels were recruited as healthy controls (HCs) to take part in the study, and all underwent rs-fMRI examination. And DC technology was used to compare the state of their cerebral spontaneous functional activity. In order to compare the average DC values of the TA group and HC group, we used independent two-sample t -test and receiver operating characteristic (ROC) curve to compare the difference of DC values between the two groups, so as to distinguish the accuracy of TA diagnosis. Finally, we also carry out Pearson’s linear regression analysis. Results. The TA group showed higher DC values in the right lingual gyrus (RLG), right precentral gyrus, and left middle temporal gyrus (LMTG) than HCs. Moreover, ROC curve analysis indicated that the area under the curve (AUC) of each cerebral region studied had high accuracy. In addition, linear analysis indicated that the DC values of the RLG were positively correlated with the Hospital Anxiety and Depression Scale (HADS) ( r = 0.844 , p < 0.001 ), and the DC values of the LMTG were positively correlated with the visual analogue scale (VAS) ( r = 0.723 , p < 0.001 ). Conclusion. TA generates abnormal changes in the intrinsic activity patterns of pain-related and vision-related areas of the cerebral cortex, which will be beneficial to reveal the underlying neuropathic mechanisms.

Introduction 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. Methods and Results 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. Conclusions 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.

Background This study aimed to estimate the prevalence of negative impacts of oral health conditions on the quality of life of quilombola and non-quilombola rural adolescents and identify associated factors. Methods This cross-sectional study was carried out in a rural area in the countryside of Bahia, Brazil, in 2015. Participants were asked to complete the Oral Impacts on Daily Performance Questionnaire. Prevalence and prevalence ratios (PR) were estimated together with their respective 95% confidence intervals. Multiple analysis was conducted using Poisson regression with robust error variance and hierarchical entry of variables. Results Of the 390 rural adolescents who took part in the study, 42.8% were quilombolas, and 45.6% of all participants reported a negative impact of their oral health conditions on their quality of life. The most prevalent impact was difficulty eating (32.6%). After adjusted analysis, the following factors were found to be associated with the negative impact of oral health conditions on quality of life: age (PR = 1.04), feeling lonely (PR = 1.42), worst evaluation of oral health (PR = 1.52), need of dental care (PR = 1.33), and occurrence of toothache in the last 6 months (PR = 1.83). Quilombolas and non-quilombolas presented with a different prevalence of discomfort when brushing their teeth and had different factors associated with the negative impact of oral health conditions on their quality of life. Both quilombola and non-quilombola rural adolescents showed a high prevalence of negative impact of oral health conditions on their quality of life. Conclusions These results support the need for improved oral healthcare for specific populations like the quilombolas. Furthermore, the results illustrate the importance of incorporating oral healthcare strategies that take into consideration the sociocultural context of adolescents.

We examined human exposures to dental products (EDP), stomatological preparations (ESP), and in the context of dental care (EDC) or toothache (ETA) registered by the Poisons Information Centre (PIC) Erfurt from 1997 to 2017. Dental products like dental technical and filling materials belong to medical devices. Stomatological preparations were classified according to the ATC code and symptom severity to the Poisoning Severity Score (PSS). In total, 156 cases of EDP (136 cases with different tooth filling materials), 1167 cases of ESP (55.6% fluoride containing products), 979 cases of EDC, and 331 cases of ETA were registered. Symptom severity in EDP and ESP were asymptomatic or mild. In ETA and EDC, however, 35 cases with moderate and 5 cases with severe symptoms were detected. 5 moderate and 3 severe cases were caused by prolonged paracetamol overdose. Severe bleeding occurred following tooth extraction in a 41 year-old phenprocoumon treated patient after self-medication with acetylsalicylic acid and metamizole. Gingival injection of lidocaine plus epinephrine in a 37 year-old healthy woman resulted in severe bradycardia and cardiac arrest. Acute toxicity of EDP and ESP appears to be low. Prolonged paracetamol overdose because of toothache, and some dental treatment can result in severe symptoms.

Background Persistent idiopathic facial pain (PIFP) is the unexplained pain along the territory of the trigeminal nerve, including nonorganic tooth pain called atypical odontalgia (AO). Though PIFP is debilitating to patients’ livelihood and well-being, its pathophysiology remains poorly understood. Although neurovascular compression (NVC) of the trigeminal nerve is known to be associated with trigeminal neuralgia (TN), the relationship between NVC and other orofacial pains has not been fully elucidated. Methods In this study, we investigated the differences in the characteristics of PIFP (primarily AO) patients in the presence or absence of NVC. A retrospective analysis was performed on data from 121 consecutive patients who had been diagnosed with unilateral PIFP according to the criteria of the International Classification of Headache Disorders (ICHD)–3 and underwent magnetic resonance imaging scans of the head. Results In the group without NVC, characteristic findings were significant for psychiatric morbidity, somatization, and pain disability, when compared with the group with NVC. Furthermore, the group without NVC exhibited significant headache, noncardiac chest pain, shortness of breath, and pain catastrophizing. Conclusions These results suggest that PIFP patients can be divided into two groups: one consistent with a neuropathic pain phenotype when NVC is present and a functional somatic symptom phenotype when presenting without NVC. Our findings may enable a more precise understanding of pathophysiology of PIFP and lead to better treatment strategies.

To examine self-reported oral health among adults aged 40 years and older with and without vision impairment.Cross-sectional, with a nationally representative sample.We used publicly available data from the Oral Health Module, last administered in 2008, of the National Health Interview Survey. Outcome variables included fair/poor oral health status, mouth condition compared to others the same age, mouth problems (mouth sores, difficulty eating, dry mouth, bad breath, and/or jaw pain), teeth problems (toothache; broken/missing fillings or teeth; loose, crooked, or stained teeth; and/or bleeding gums), and lack of social participation. Using descriptive statistics and multivariate logistic regression, we examined the association (P.05) between vision impairment and oral health outcomes by age group, sociodemographics, and other explanatory variables.Our study sample included 12,090 adults; 12.8% of adults aged 40-64 years reported vision impairment, and among them, 44.5% reported fair/poor oral health status and 47.2% reported any mouth problems. Among adults aged ≥65 years, 17.3% reported vision impairment, of whom 36.3% reported fair/poor oral health status and 57.3% reported any mouth problems. There is a strong association between vision impairment and poorer oral health of adults; adults aged 40-64 years with vision impairment reported 90%-150% greater odds of oral health problems, including fair/poor oral health status, mouth problems, and teeth problems, compared to people without vision impairment.Oral health disparities exist between adults with and without vision impairment. Targeted interventions are required to improve oral health in this vulnerable population.

Objectives Nationally representative studies on socioeconomic differences in toothache prevalence are very limited, especially with a long follow-up period. Our aim was to examine the education-related differences in toothache prevalence among 25- to 64-year-olds in Finland during 1990-2014. Methods We used data from the Health Behaviour and Health Among the Finnish Adult Population surveys. Data were gathered by random samples of 15- to 64-year-old Finns annually between 1990 and 2014. Response rates decreased during this period from 76% (n = 3812) to 53% (n = 2630). Our final pooled total sample size was 63 372 after exclusion of edentate participants and missing data. Relative educational level was used to measure socioeconomic position. In addition to basic tabulations, educational differences in toothache prevalence during the past month were investigated using the multiple additive regression tree for mediation analysis. Results The proportion of respondents who reported having had toothache during the past month increased from 7% to 12% from 1990 to 2014. Educational differences in toothache prevalence were small for the whole study period, especially in women. Men with high relative education had a lower toothache prevalence than people with low relative education during 1990-1994 and 2010-2014. This stemmed from the direct effect of relative education and the indirect effects of toothbrushing frequency, number of missing teeth and perceived health. In both sexes, those with middle-level relative education had higher toothache prevalence than people with low relative education 1995-2009. Conclusions During 1990-2014, toothache prevalence increased among 25- to 64-year-olds in Finland. Since the mid-1990s, differences in toothache prevalence by relative education remained very small in both sexes. More actions are needed to understand reasons behind the clearly increased toothache prevalence in Finland during the last decades.

Aim To assess whether persistent idiopathic dentoalveolar pain (PIDAP), a diagnosis of exclusion, exhibits common features that can facilitate its diagnosis. PIDAP is defined by the International Classification of Orofacial Pain (ICOP 6.3.) as "Persistent unilateral intraoral dentoalveolar pain, rarely occurring in multiple sites, with variable features but recurring daily for more than 2 hours per day for more than 3 months, in the absence of any preceding causative event." Methodology In this observational study, participants fulfilling the new International Classification of Orofacial Pain (ICOP) diagnostic criteria of PIDAP were included, covering 16 years of consecutive data. A systematic, retrospective assessment of patients utilising the new PIDAP criteria on complaints of chronic tooth pain in a referral-based endodontic practice was undertaken. Non-idiopathic cases were excluded on the basis of clinical and radiologic findings. A modified neuropathic pain questionnaire was used to describe the painful sensations. Furthermore, allodynia in the periodontal space and sensory changes in the oral mucosa were assessed using a periodontal probe. Results Among the 160 patients assessed, 78 (63 women) fulfilled the strict PIDAP criteria. Pain history of PIDAP included no nocturnal awakening (85%) and a "pulling/dragging" pain quality (59%). In 69% of the patients with PIDAP, pain was associated with a root filled tooth at the same site. In 14% of the cases, no endodontic treatment was performed in the affected quadrant. Mechanical allodynia in the gingival sulcus was observed in 90% of patients with painful teeth or implants. Conclusions In this observational study, PIDAP mainly affected females and was associated with undisturbed sleep and periodontal allodynia.

Background: The purpose of this study was to introduce a new Oral Health Activities Questionnaire (OHAQ, hereinafter) that examines different activities and behaviours related to the oral hygiene regimen of each analysed subject. Methods: A sample of 658 students was analysed to determine the OHAQ scale’s basic metric characteristics. To determine the construct validity of the OHAQ, descriptive statistics and correlation analysis, as well as differences testing, were applied to groups of subjects on the basis of self-reported oral status measures. Results: The dimensions of oral health activities were determined, and the scales for their measurement were constructed. Females and males differed in the OHAQ questionnaire measures. Significant but low intercorrelations were found among the measures. In the female and male subsample, four different oral health (OH, hereinafter) types of subjects were identified, exhibiting different characteristic behaviours regarding oral health. OHAQ scales showed good discriminant validity, revealing the differences related to specific self-reported oral status measures (e.g., frequency of toothache and the number of filled teeth). Conclusions: The OHAQ represents a satisfactory measurement instrument for determining the level of OH activities and for doing quick and reliable classifications of the participating subjects according to their OH activities and behaviours. The process of further validation and advancements of the OHAQ scales and measures should be continued through a clinical examination of subjects.

Information on long-term trends in toothache prevalence is scarce. The aim of this study was to assess age-, period-, and cohort-related changes in toothache prevalence among 15- to 64-yr-old adults in Finland between 1990 and 2014 by using annual, representative postal surveys, albeit with decreasing response rates from 76% (n = 3,812) to 53% (n = 2,630). Age-period-cohort analysis of toothache prevalence during the past month was performed. Logistic regression analyses were conducted to account for other factors contributing to toothache. Toothache prevalence increased from 7% to 12% during the time period 1990 to 2014. Age-period-cohort analysis revealed that toothache prevalence increased from cohort to cohort, especially from the 1960 birth cohorts onwards (cohort effect). Adults under 30 yr of age had the highest toothache prevalence (~17%), while, in those over 30 yr of age, toothache prevalence decreased steadily according to age (to ~5% at age 64 yr, age effect). Toothache prevalence peaked at ~ 11% in the mid-2000s (period effect). Toothache was strongly associated with poorer perceived health and lower toothbrushing frequency and less strongly associated with higher educational level, a higher number of missing teeth, history of smoking, being single, separated, or divorced, and female gender. The increase in toothache prevalence occurred especially from 1990 to the mid-2000s, and mainly among younger age groups and more recent cohorts.

Background Dental health is often neglected by the majority of the population and has contributed to the global burden of oral diseases. We assessed awareness, utilization and barriers to seeking oral health care among adults in Nebbi District, Uganda. Methods A community-based, cross sectional study was conducted in the central division, Nebbi District in Uganda among adults between the age of 18 years or older. An interviewer-administered, semi-structured questionnaire was used for data collection on socio-demographic characteristics, oral health awareness, oral health utilization, associated factors and barriers. Results A total of 400 adults with a median age of 32 years (interquartile range 24–43) years were enrolled. More than half (57.5%, n = 230) of the participants were female. Participants identified smoking (42.8%, n = 171) and consumption of sugary foodstuffs (29.0%, n = 116) as risk factors for oral disease. Not brushing was also identified by 260 participants (65.0%) as the cause of tooth decay and 95.8% (n = 383) believed brushing one’s teeth could prevent tooth decay. Of the 51.5% (n = 206) who had experienced a toothache or discomfort 12 months prior to the study but only about half (52%, n = 106) had sought healthcare from a dental clinic or facility. About 89.5% (n = 94) of the participants were able to see a dentist during their last visits. Dental carries (76.6%, n = 70) and gum bleeding (14.9%, n = 14) were the most frequent reasons for visiting a dental clinic, and 73.7% (n = 70) had their tooth extracted. Barriers to seeking oral healthcare were cost of treatment (47.5%, n = 190), and long waiting time (18.5%, n = 74). The odds of seeking oral healthcare was 2.8-fold higher in participants who were being married (Odds ratio (OR): 2.8, 95% CI 1.3–6.3, p = 0.011) and 3.5-fold higher among housewives (COR: 3.5, 95% CI 1.1–11.4, p = 0.040). Conclusion About half of the participants had sought healthcare following a dental condition. Cost of treatment seems to be an important factor affecting utilization of oral health services. Optimization of costs, and creating awareness regarding benefits of utilizing preventive dental services are recommended.

OBJECTIVES This study was performed to examine changes in the number of patient visits and types of oral services in an oral emergency department from the beginning to the control stage of the coronavirus disease 2019 (COVID-19) outbreak in Beijing. METHODS The numbers of daily oral emergency visits from January 20 to March 24, 2020, at a dental university hospital in Beijing and daily newly confirmed COVID-19 cases in Beijing during the same period were collected and analysed. All oral emergency patient information (including sex, age, and oral diagnosis) was also collected and analysed. Patients with incomplete medical data were excluded. RESULTS In total, 12,416 patients were included in this study. The number of daily emergency visits was negatively correlated with the number of newly confirmed local COVID-19 cases in Beijing (P < .001). The number of daily emergency visits during the COVID-19 stable period in Beijing was greater than that during the outbreak period (P < .001). Compared to those in the COVID-19 outbreak period, the percentages of females, children and adolescents, patients with acute toothache, and patients with nonurgent cases were higher in the stable period, and the numbers of patients with toothache, trauma, infection, and nonemergency conditions increased in the COVID-19 stable period (P < .001). CONCLUSIONS COVID-19 significantly influenced the number of patient visits and the percentages of patients with oral emergency situations in the oral emergency department. There were obvious differences in treatment seeking for oral emergencies between the COVID-19 periods in Beijing. There was an inverse relationship between daily oral emergency visits and daily confirmed COVID-19 cases in Beijing.

Gymnosporia montana (Roth) Benth an herbaceous shrub used in Indian traditional medicine their leaves decoction was used as mouthwash to get relieve from toothache, hence it is also known as Dantakashta in Sanskrit language which means the plant used for tooth problems. Traditionally the leaves juice used to alleviate inflammation and in some parts of India like Saurashtra in Gujarat, leaves were chewed as a folklore cure for Jaundice and in Bhandra region Karnataka, leaves extract mixed with cow milk used for jaundice. Hepatoprotective activity for G. montana leaves was well reported however, its use for inflammation and toothache are still not studied to investigate active phytoconstituents responsible for anti-inflammatory activity.The present study aimed at bioactivity guided isolation of G. montana leaves extracts using inhibition of pro-inflammatory mediators such as nitric oxide (NO), tumor necrosis factor (TNF-α), and interleukins (IL-1β and IL-6) in RAW 264.7 cells in vitro assay to yield bioactive phytoconstituents.The n-hexane, ethyl acetate and methanol extracts prepared from G. montana leaves were evaluated for cell viability using MTT assay. The effect of extracts to inhibit the pro-inflammatory mediators like NO, TNF-α, IL-1β and IL-6 in RAW 264.7 macrophages was measured by enzyme-linked immunosorbent assay (ELISA). The quantitative analysis of the isolated phytoconstituents was performed using quantitative Nuclear Magnetic Resonance (qNMR).The n-hexane, ethyl acetate, and methanol extracts of G. montana leaves exhibited cell viability in the range of 97.43-84.88% at 50 μg/mL concentration in RAW 264.7 macrophages. In-vitro evaluation of extracts showed that n-hexane extract was most effective in inhibiting NO, TNF-α, IL-1β and IL-6 inflammatory mediators at 50 μg/mL in lipopolysaccharides (LPS) stimulated RAW 264.7 cells. Further n-hexane extract, its fraction GMHA3 and β-amyrin exhibited significant anti-inflammatory activity at 100, 50 and 30 mg/kg per oral, respectively in carrageenan-induced rat paw edema. The quantitative analysis by qNMR revealed β-amyrin as a major compound in the n-hexane extract.In vitro and in vivo bioassay results suggested that G. montana n-hexane extract, its fraction GMHA3 and β-amyrin exhibits significant anti-inflammatory activity proves the traditional uses of G. montana leaves. The reported activity of β-amyrin for periodontitis provides evidence of profound the use of G. montana leaves for toothache and anti-inflammatory activity.

Local anesthetics (LA) have been used for a wide variety of procedures over the years due to their analgesic effect. These drugs have been seen to cause adverse events in the pediatric population, but an actual allergy must be in question. A case of an apparent hypersensitivity reaction to LA used in the setting of dental procedures in a 14.5-year-old girl with a forgotten history of asthma was reported and medical documentation review was performed. After treatment with LA during several dental procedures, the patient presented the shortness of breath, malaise and fainting, which then resolved spontaneously. After proper history taking, and skin and provocation tests, the patient was diagnosed with bronchial asthma and emotional sensitivity. The patient's recommendation included using an antihistamine and controlling her asthma before the use of LA, and administering the drug in a supine position. It is essential to consider all possible etiologies of an adverse event after using drugs in the pediatric population and to perform proper testing before making the diagnosis of a drug allergy.

Aims: 1 Describe the epidemiology and determine risk factors for COVID-19 associated mucormycosis. 2 Elaborate the clinical spectrum of Rhino-Orbital-Cerebral Mucormycosis (ROCM), pattern of neuroaxis involvement and it's radiological correlates. Methods Observational study. Consecutive, confirmed cases of mucormycosis (N = 55) were included. A case of mucormycosis was defined as one who had clinical and radiological features consistent with mucormycosis along with demonstration of the fungus in tissue via KOH mount/culture/histopathological examination (HPE). Data pertaining to epidemiology, risk factors, clinico-radiological features were analysed using percentage of total cases. Results Middle aged, diabetic males with recent COVID-19 infection were most affected. New onset upper jaw toothache was a striking observation in several cases. Among neurological manifestations headache, proptosis, vision loss, extraocular movement restriction; cavernous sinus, meningeal and parenchymal involvement were common. Stroke in ROCM followed a definitive pattern with watershed infarction. Conclusions New onset upper jaw toothache and loosening of teeth should prompt an immediate search for mucormycosis in backdrop of diabetic patients with recent COVID-19 disease, aiding earlier diagnosis and treatment initiation. Neuroaxis involvement was characterized by a multitude of features pertaining to involvement of optic nerve, extraocular muscles, meninges, brain parenchyma and internal carotid artery.

The aim of the study is: (a) investigate the racial inequalities as one specific dimension that affects dental pain in Brazilian adolescents; and (b) investigate the regional variations of dental pain. This cross-sectional study used data from Brazilian National Survey of School Health (PeNSE), carried out with adolescents in 2009, 2012 and 2015. Dental pain was evaluated through the question: “Did you have dental pain in the last six months?”. The main exposures were race and Brazilian regions, used to evaluate inequalities related to the outcome. Sex, age, school type and maternal education were used as covariables. The statistical significance of the trends in dental pain was tested using linear regression. The analysis was conducted in Stata 13.0 statistical package using the svy command. The standard prevalence of dental pain was 18.8%, 21.1% and 23.7%, showing an increasing trend over time (p < 0.001). We observed absolute inequalities in dental pain related to race and regions. A higher prevalence was found in non-white girls of public schools and in the Northern Region. The indexes of inequalities increased in the group of black girls, related to an increase of dental pain predominantly in girls whose mothers had lower educational level. It was observed that the prevalence of dental pain in Brazilian adolescents increased over time as well as its inequalities, which remained in marginalized populations and linked to Brazilian regions. Resumo: O estudo teve dois objetivos: (a) investigar as desigualdades raciais enquanto uma dimensão específica que afeta a prevalência de dor de dente em adolescentes brasileiros, e (b) analisar as variações regionais na prevalência de dor de dente. O estudo transversal usou dados da Pesquisa Nacional de Saúde do Escolar (PeNSE), realizada com adolescentes em 2009, 2012 e 2015. Dor de dente foi avaliada com a pergunta: “Nos últimos seis meses, você teve dor de dente?”. As principais exposições foram raça/cor e macrorregiões brasileiras, usadas para avaliar as desigualdades relacionadas ao desfecho. Sexo, idade, tipo de escola e escolaridade materna foram as covariáveis utilizadas. A significância estatística das tendências na prevalência de dor de dente foi testada com regressão linear. As análises foram realizadas com o programa estatístico Stata 13.0, usando o comando svy. A prevalência padrão de dor de dente foi 18,8%, 21,1% e 23,7%, com uma tendência crescente ao longo do tempo (p < 0,001). Foram observadas desigualdades absolutas na prevalência de dor de dente de acordo com raça e macrorregião. A prevalência mais alta esteve associada ao sexo feminino, raça não-branca, escola pública e Região Norte do país. Os índices de desigualdade aumentaram no grupo de meninas negras, refletidos em um aumento na prevalência de dor de dente em meninas cujas mães tinham menos escolaridade. A prevalência de dor de dente em adolescentes brasileiros aumentou ao longo do tempo, e as desigualdades em relação à dor de dente persistiram nas populações marginalizadas e de acordo com a região do país. Resumen: El objetivo del estudio fue doble: (a) investigar las desigualdades raciales, como una dimensión específica que afecta al dolor dental, en adolescentes brasileños; e (b) investigar las variaciones regionales del dolor dental. Este estudio transversal usó datos de la Encuesta Nacional de Salud del Escolar (PeNSE), llevada a cabo con adolescentes en 2009, 2012 y 2015. El dolor dental fue evaluado por la pregunta: “En los últimos seis meses, ¿sufriste dolor dental?”. Los principales factores de exposición fueron raza y regiones brasileñas, y se usaron para evaluar las desigualdades relacionadas con los resultados. Sexo, edad, tipo de escuela y educación maternal fueron las covariables usadas. La significación estadística de las tendencias en el dolor dental fue probada usando regresión lineal. El análisis se realizó con el paquete estadístico Stata 13.0, usando el comando svy. El estándar de prevalencia de dolor dental fue 18,8%, 21,1% y 23,7%, con tendencia a aumentar a lo largo del tiempo (p < 0.001). Se observaron desigualdades absolutas en el dolor dental, relacionadas con raza y regiones. Se encontró una prevalencia más alta en chicas, de raza no blanca, escuelas públicas y Región del Norte. Los índices de desigualdades se incrementaron en el grupo de chicas negras, en detrimento de un incremento en la prevalencia del dolor dental en chicas cuyas madres contaban con menos educación formal. Se observó que la prevalencia de dolor dental en adolescentes brasileñas se incrementó a lo largo del tiempo y las desigualdades, respecto al dolor dental, continuaron manteniéndose en el tiempo en poblaciones marginalizadas y acordes con determinadas regiones brasileñas.

Couvade Syndrome is best characterized as a somatic symptom disorder where the partner experiences somatic symptoms during their partner's pregnancy most often during the first and third trimesters. Several psychoanalytical theories have been proposed for this disorder. There are well studied mood changes that correspond to hormonal shifts that occur in response to anticipated parenthood which serve as a physiologic mechanism for this pathology.The following is a case of Couvade syndrome in the setting of a high risk pregnancy complicated by pre-eclampsia with severe features necessitating a preterm delivery.Expectant fathers should be screened for symptoms of Couvade Syndrome throughout the pregnancy in order to better support the familial unit.

The purpose of this study was to demonstrate the ability of a custom window blending algorithm to depict multicompartmental disease processes of the maxillofacial region in a single image, using routine computed tomography (CT) DICOM data. Five cases were selected from case files demonstrating trauma, infection, and malignancy of the maxillofacial region on routine CT examinations. Images were processed with a modified Relative Attenuation-Dependent Image Overlay (RADIO) window-blending algorithm in Adobe Photoshop controlled by ExtendScript. The modified RADIO algorithm was able to demonstrate pertinent multicompartmental imaging findings in each of the examinations, allowing simultaneous visualization of clinically relevant bone and soft tissue findings in a single image, without needing to change window and level settings. A custom window blending algorithm can demonstrate a range of multicompartmental pathology in the maxillofacial region in a single image.

Objective: To investigate the relationship between subjective symptoms of orofacial pain and oral health-related quality of life (OHRQoL), as well as psychological distress in population-based midd...

Background Pain descriptors capture the multidimensional nature of pain and can elucidate underlying pathophysiological mechanisms. This study determined whether the pain descriptors chosen by subjects experiencing acute dental pain associate with the outcomes of two commonly performed dental sensory tests. The goal of the study is to clarify whether pain descriptors are useful in discriminating the underlying biological processes contributing to dental pain. Methods Participants (n = 228) presenting with acute toothache underwent standardized clinical dental sensory testing and described their pain in reference to 22 pain quality descriptors. Univariate and two-way ANOVA determined the relationship between groups defined by cold detection (positive or negative) and percussion hypersensitivity (painful or not) on the affected tooth, and pain descriptor reporting. Results Subjects experiencing painful toothache most frequently reported evoked pain to temperature and chewing, and pain descriptors such as "throbbing" and "aching." They also reported neuropathic pain descriptors such as "tingling" and "electric shock." Subjects who detected a cold stimulus (thermal) on the affected tooth, frequently reported high intensity paroxysmal shooting pain compared to those that did not detect cold. By contrast, patients with percussion (mechanical) hypersensitivity on the affected tooth, reported higher levels of global pain intensity at rest and in function, and reported significantly higher intensity "radiating" and "throbbing" pain, than subjects with non-painful percussion. Conclusions The reporting of neuropathic pain descriptors by subjects experiencing acute toothache was more frequent than expected, suggesting that neuropathic mechanisms could contribute to typical toothache pain. Subjects experiencing toothache with mechanical hypersensitivity experience more intense pain overall. Significance In subjects experiencing acute toothache, specific pain descriptors associate with the responses to routine clinical sensory tests performed on the injured tooth. The frequent reporting of neuropathic pain descriptors suggests that neuropathic mechanisms could create a diagnostic challenge to differentiate toothache from intraoral neuropathic conditions. Persons experiencing toothache with mechanical hypersensitivity experience more intense pain overall, suggesting patients with this clinical feature will have distinct clinical pain management needs.

AIMS To investigate whether acute dental pain due to pulpal or periapical inflammation is associated with increased expression of cortisol and inflammatory markers and mediators in the saliva, as well as changes in salivary flow rate. METHODS Patients experiencing pain (n = 42) were recruited when seeking emergency dental treatment. A 0 to 10 numeric rating scale (NRS) was used as a measure of the severity of pain, and the number of days with pain sensation was also recorded. Unstimulated saliva was collected for 3 minutes (salivary flow measured in mL/minute) and stored at -80°C. Saliva was analyzed for the biomarkers cortisol, C-reactive protein (CRP), and cytokines interleukin-1β (IL-1β) and interleukin-6. In addition, the participants completed a simple questionnaire about stress-inducing factors such as insomnia, dental anxiety, or home/workplace stress. Patients received a dental examination and diagnosis (eg, symptomatic pulpitis/apical periodontitis or acute apical abscess), which was confirmed during dental treatment. The control group (n = 39) consisted of participants without any pain and no known medical or dental problems. RESULTS Patients experiencing acute pain due to pulpal or periapical inflammation had a mean NRS score of 7.0 ± 2.59. The mean duration of pain was 6.5 ± 7.9 days. There was no significant difference in pain level between male and female subjects, tooth type affected, or diagnosis. Higher levels of cortisol, IL-1β, and IL-6 and increased salivary flow were detected in patients with pain when compared to controls (P < .05). CRP was higher in patients with acute pain compared to control participants without pain, but this difference was not statistically significant. Stress at home or the workplace was reported by 79% of patients experiencing pain and by 28% of control participants. CONCLUSION Acute dental pain due to pulpal or periapical inflammation was associated with an increase in salivary cortisol, IL-1β, and IL-6 levels and in salivary flow rate. Stress arising from home or the workplace may aggravate a symptom-free pulpal or periapical inflammation to an acute phase. Inflammation in the pulp and periapical region can have effects in regions remote from the disease site.

Objectives Opiorphin is a recently discovered peptide shown to inhibit the enkephalin-degrading enzymes and prolong the effects of enkephalins. Although opiorphin is found in high concentrations in saliva, the relationship between salivary opiorphin and orofacial pains is not yet fully understood. We aimed to determine salivary opiorphin concentrations in dental pain related to symptomatic irreversible pulpitis (SIP), and symptomatic apical periodontitis (SAP). Design 39 patients participated in this study. The participants were categorized into SIP and SAP based on their diagnosis. All the patients were treated with root canal treatment. Saliva specimens were collected, and pain levels were recorded at pre-treatment, 7 days post-treatment and 30 days post-treatment. Saliva opiorphin levels were measured using a commercially available ELISA kit. Pre-treatment and post-treatment opiorphin levels were evaluated using repeated measures ANOVA. Correlations between VAS scores, opiorphin levels and age were evaluated using Spearman’s Rank Correlation. Results The average saliva opiorphin level pre-treatment, 7 days post-treatment and 30 days post-treatment were 31.28 ± 7.10 ng/ml, 20.41 ± 2.67 ng/ml and 18.61 ± 2.05 ng/ml respectively. Significantly higher pre-treatment opiorphin levels were observed in the SIP group compared to the SAP group. A strong correlation was observed between the pre-treatment pain levels and the saliva opiorphin concentrations. Conclusions Our findings indicate that saliva opiorphin levels increase in inflammation related dental pain. The level of salivary opiorphin is strongly correlated with the reported level of pain. The extent of the inflammation (pulpal vs. periodontal) also affects the opiorphin level.

BACKGROUND: The number of people with dementia and natural dentition is growing. As dementia progresses, the degree of self-care decreases and the risk of oral health problems and orofacial pain increases.OBJECTIVES: To examine and compare the presence of orofacial pain and its potential causes in older people with Mild Cognitive Impairment (MCI) or dementia.METHODS: In this cross-sectional observational study, the presence of orofacial pain and its potential causes was studied in 348 participants with MCI or dementia with all levels of cognitive impairment in two outpatient memory clinics and ten nursing homes.RESULTS: Orofacial pain was reported by 25.7% of the 179 participants who were considered to present a reliable pain self-report (Mini-Mental State Examination score ≥14 points), while it could not be determined in people with more severe cognitive impairment. The oral health examination of the 348 participants indicated that potential painful conditions, such as coronal caries, root caries, tooth root remnants or ulcers were present in 50.3%. There was a significant correlation between the level of cognitive impairment and the number of teeth, r = 0.185, P = 0.003, teeth with coronal caries, r = -0.238, P < 0.001, and the number of tooth root remnants, r = -0.229, P = 0.004, after adjusting for age.CONCLUSIONS: This study indicated that orofacial pain and its potential causes were frequently present in participants with MCI or dementia. Therefore, a regular oral examination by (oral) healthcare providers in people with MCI or dementia remains imperative, even if no pain is reported.

The objective of the present study was to evaluate the influence of individual and contextual factors on the occurrence of toothache in five-year-old children. A cross-sectional study was conducted with 756 five-year-old children from public and private preschools in a city in the countryside of the northeast of Brazil. The sample was determined through probabilistic sampling in two stages (preschools and children). The children included could not have systematic diseases, permanent tooth or orthodontic treatment. Parents/caregivers were required to spend at least 12 hours per day with their children. The history of toothache during the life of the child was reported by parents/guardians. Socioeconomic and psychological questionnaires were completed by parents/guardians. Variables related to social context were obtained from the preschools in which the children studied and the official publications of the municipal region. Unadjusted and adjusted multilevel Poisson regression models were used to investigate the association between individual and contextual characteristics and history of toothache. The history of toothache was found for 23.8% of the children. Among the individual determinants, gender of the child, order of birth, and schooling of parent/guardian were associated with toothache in children. The individual variables remained associated with the outcome after the addition of the contextual variables to the model. The type of preschool was the contextual determinant associated with toothache in the final model. Both individual (gender, order of birth and schooling of parents/guardians) and contextual (type of preschool) determinants were associated with history of toothache in five-year-old children. Resumo O objetivo do presente estudo foi avaliar a influência de fatores individuais e contextuais na ocorrência de dor de dente em crianças de cinco anos de idade. Um estudo transversal foi realizado com 756 crianças de cinco anos de idade de pré-escolas públicas e privadas em uma cidade no interior do Nordeste do Brasil. A seleção da amostra foi realizada por meio de amostragem probabilística em duas etapas (pré-escolas e crianças). As crianças incluídas não poderiam ter doenças sistêmicas, dentes permanentes ou tratamento ortodôntico. Foram incluídos apenas pais/responsáveis que passavam pelo menos 12 horas por dia com seus filhos. O histórico de dor de dente durante a vida da criança foi relatado pelos pais/responsáveis. Os questionários socioeconômicos e psicológicos foram preenchidos pelos pais/responsáveis. As variáveis relacionadas ao contexto social foram obtidas na pré-escola em que as crianças estudaram e nas publicações oficiais da região municipal. Os modelos de regressão de Poisson multinível não ajustados e ajustados foram utilizados para investigar a associação entre características individuais e contextuais e histórico de dor de dente. O histórico de dor de dente foi encontrado em 23,8% das crianças. Entre os determinantes individuais, gênero da criança, ordem de nascimento e escolaridade dos pais/responsáveis foram associados com dor de dente em crianças. As variáveis individuais permaneceram associadas ao resultado após a adição das variáveis contextuais ao modelo. O tipo de pré-escola foi o determinante contextual associado ao histórico de dor de dente no modelo final. Tanto o indivíduo (gênero, ordem de nascimento e escolaridade dos pais/responsáveis) quanto os determinantes contextuais (tipo de pré-escolar) foram associados com o histórico de dor de dente em crianças de cinco anos de idade.

Patients with factitious disorder typically present with signs or symptoms suggesting a medical problem, but which transpire to be self-induced or fabricated. Repeated investigations and treatments are often carried out to no avail before this possibility is considered. In this case, a 51-year-old female presented to the oral and maxillofacial surgery unit with toothache and a facial rash. Following admission to hospital a range of investigations were performed, and a tooth was extracted. Judicious attention by nursing staff led to the discovery that the patient had been applying make-up to mimic a skin rash. This concern was raised with the patient and she admitted falsifying the rash. Although this patient may have been experiencing pain, by applying make-up in this manner she sought to exaggerate the severity of her condition and as a result underwent potentially unnecessary procedures. This case provides a reminder that the possibility of factitious disorder should be considered in cases where patients present with symptoms or signs which appear fabricated or self-inflicted, defy anatomical or physiological principles, or do not correlate with the history. Thorough history taking is essential, and access to electronic care records may be informative. Psychiatric follow-up is recommended, but not all patients are willing to engage with this process.

OBJECTIVES This systematic review aimed to determine the pooled prevalence of toothache in children and adolescents and to verify its association with sociodemographic characteristics and dental caries experience. MATERIAL AND METHODS Six main and three grey literature databases were searched in February 2021. Observational studies that assessed the prevalence of toothache and associated factors were included. The methodological quality of the studies was evaluated following the guidelines by Fowkes and Fulton. Proportion and association meta-analyses were performed in MedCalc and Revman software, respectively. The certainty of the evidence was determined with the GRADE approach. RESULTS Seventy-one studies met the inclusion criteria. Thirty-two presented high methodological quality and a low risk of bias. The overall pooled prevalence of toothache in children and adolescents was 36.2% (95%CI: 33.0-39.42; I2: 99.72%; P

Objective: To evaluate the association of dental pain with time living on the street in a sample of homeless people in the city of Porto Alegre, Brazil. Methods: A cross-sectional study was carried out with homeless people who accessed social services in 2017. A questionnaire was administered covering socioeconomic variables and including questions about general health, use of tobacco/alcohol/drugs, use of dental services and history of dental pain. The decayed, missing, and filled teeth (DMFT) index was calculated in an oral examination. The association between socioeconomic characteristics, health status, time of homelessness and dental pain was evaluated using chi-square, t-, and Mann-Whitney tests. Results: A total sample of 214 homeless people was surveyed. Most were male (76.2%), had a low level of education (67.6%) and experienced many episodes of dental pain during life (91.0%). The last episode of pain was moderate or intense (79.7%) and do-it-yourself measures for pain relief were preferred (62.3%). Individuals who were homeless for longer than 1 year had more dental pain in the past (P < 0.001), more frequency of a recent episode of dental pain (P = 0.03), and sought a dentist or healthcare service to relieve pain less frequently (P = 0.03). Conclusions: Dental pain is frequent in the context of homelessness and does not necessarily result in seeking dental services, even where there is universal oral health care.

Objective. To assess the effect of low-level laser applied at 3 weeks intervals on orthodontic tooth movement (OTM) and pain using conventional brackets (CB). Materials and Methods. Twenty patients with Angle’s class II div 1 (10 males and 10 females; aged 20.25 ± 3.88 years) needing bilateral extractions of maxillary first bicuspids were recruited. Conventional brackets MBT of 0.022 in slot (McLaughlin Bennett Trevisi) prescription braces (Ortho Organizers, Carlsbad, Calif) were bonded. After alignment and levelling phase, cuspid retraction began with nitinol closed coil spring on 19 × 25 stainless steel archwire, wielding 150 gram force. 7.5 J/cm2 energy was applied on 10 points (5 buccal and 5 palatal) on the canine roots on the investigational side using gallium-aluminum-arsenic diode laser (940 nm wavelength, iLase™ Biolase, Irvine, USA) in a continuous mode. Target tissues were irradiated once in three weeks for 9 weeks at a stretch (T0, T1, and T2). Patients were given a feedback form based on the numeric rating scale (NRS) to record the pain intensity for a week. Silicon impressions preceded the coil activation at each visit (T0, T1, T2, and T3), and the casts obtained were scanned with the Planmeca CAD/CAM™ (Helsinki, Finland) scanner. Results. The regimen effectively accelerated (1.55 ± 0.25 mm) tooth movement with a significant reduction in distress on the investigational side as compared to the placebo side (94 ± 0.25 mm) ( p < 0.05 ). Conclusions. This study reveals that the thrice-weekly LLLT application can accelerate OTM and reduce the associated pain.

Dental fear is a challenging problem in dentistry and many contributing factors have been identified. Although this problem among children and adolescents has been studied in the literature for a long time, few such studies have been conducted in Lithuania. This study aimed to evaluate the prevalence of dental fear and examine its association with gender, age and several psychological and social factors among children and adolescents in Lithuania. The cross-sectional survey included a randomly selected sample (n = 1590) of children aged 11–14 and adolescents aged 15–18. The data were supplemented by interviewing the parents of these subjects (n = 1399). Dental fear was measured with a single five-score question. The data collection also included questions on oral health, socioeconomic status, oral health-related quality of life and self-esteem. Poisson regression analysis was used to assess the association between perception of dental fear and potential predictor variables. It was found that 32.2% (95% CI: 29.9–34.4%) of children and adolescents reported no fear of dental treatment, 12.5% (10.8–14.2%) of their peers were highly afraid of dental treatment, and other subjects assessed their dental fear gradually. Girls reported greater dental fear scores than boys, but the level of dental fear did not depend on the age. We identified the groups of subjects by gender and age, and a higher level of dental fear was significantly associated with untreated caries experience, a delay in the age of the subject’s first visit to the dentist, low self-esteem, low oral health-related quality of life, low overall life satisfaction and low family affluence. The results also suggested that dental fear could originate from previous toothache, dentists’ actions, high sensitivity in the child and poor psychological readiness for treatment. It was concluded that dental fear among Lithuanian children and adolescents is a common problem that is associated with gender and several dental, psychological and social factors. The findings indicate that school-based health policies, paediatric dentists and parents should be encouraged to focus on the psychosocial factors associated with dental fear because most of them can be prevented.

Objective: To assess the use of self medication in oral health problems in Cameroon. Methods: This multi-regional cross-sectional survey was conducted in three towns; Bamenda, Yaounde and Buea over a 10 month period. The questionnaire elicited information on demography, oral problem for self medication, substance used for self medication, source of the substance, duration of self medication, reason for self medication, source of advice of the drugs or those products used, opinion about the substance, effect and duration. Results: The prevalence of self medication for oral health problems was 67.8% which was significantly associated with age, marital status and location. The most frequently self medicated oral health problem was toothache (54.7%). The majority (64.5%) of the respondents used pharmaceutical products while a minority (7.7%) used dangerous substances such as petrol and vinegar for self medication. Sources of substances of self medication included pharmacy (55.6%), road side vendors (26.1%), native healers (7.8%), mobile drug vendors in buses (5.3%), and others (5.3%). The choice of substances used for self medication was mostly guided by the advice from relatives. Conclusion: The majority of the respondents self-medicated for oral health problems. Unmarried, urban residents, aged 21–30 years reported significantly increased self-medication for oral health problems. Evidently dangerous substances were utilised for self-medication in this study, necessitating awareness and other forms of intervention.

Context Self-care is one of the ways in which people without access to professional care can actively engage in managing their oral health problems. Aim To find out the prevalence of dental pain and the type of self-care remedies utilised for pain relief by people with low socio-economic status residing in Kollipara mandal, Guntur district, Andhra Pradesh. Settings and design This was a cross-sectional population-based study. Methods and material A multistage simple random-sampling technique was adopted to obtain an appropriate sample. A questionnaire, which consisted of sections on socio-economic and demographic variables, dental pain, pain characteristics and self-care remedies utilised to combat dental pain, was used to collect data. Statistical analysis used the chi-square test and descriptive statistics. Results The survey covered a total population of 630 individuals. The mean age of the population was 32.8 ± 16.7 years. Among the total study subjects, 44.1% were male and 55.9% were female. The prevalence of dental pain reported during the preceding 6 months was 28.3%. Subjects who experienced dental pain reported the home remedies and self-care methods that they utilised to get relief from the pain. They more frequently reported using over-the-counter medication (49.6%) for pain relief. Conclusions This study provides an insight into the type and usage of self-care in relief of dental pain. Pain sufferers used a variety of self-care methods to deal with their problems.

Background Neuropathic dental pain (NDP) is a chronic pain condition that is notoriously difficult to treat. To date, there are no deep brain stimulation (DBS) studies on this specific pain condition and no optimal target or "sweet spot" has ever been defined. Objective To determine the optimal thalamic target for improving this condition by utilizing the steering abilities of a directional DBS electrode (Vercise CartesiaTM Model DB-2202-45, Boston Scientific). Methods A literature search and review of our database identified 3 potential thalamic targets. A directional lead was implanted in a patient with NDP and its current steering used to test the effects in each nucleus. The patient reported her pain after 2 wk of stimulation in a prospective randomized blinded trial of one. Quality of life measurements were performed before and after 3 mo on their best setting. Results We identified 3 potential nuclei: the centromedian (CM), ventral posterior medial (VPM), and anterior pulvinar. The best results were during VPM stimulation (>90% reduction in pain) and CM stimulation (50% reduction). Following 3 mo of VPM-DBS in combination of lateral CM stimulation, their pain disability index dropped (from 25 to 0) and short form 36 improved (from 67.5 to 90). Conclusion VPM stimulation in combination with CM stimulation is a promising target for NDP. DBS electrode directionality can be used to test multiple targets and select a patient specific "sweet spot" for NDP treatment.

The Indonesian family life survey (IFLS) is used for formulating various government policies. Our preliminary study using data from the IFLS showed increase in the prevalence of toothache from 2007 to 2014. Hence, a need to analyse the factors associated with toothache using structural equation modelling (SEM) for identifying the direct and indirect association of factors with toothache was evident. The objective of this study is to analyse the complex relationships between toothache and its associated risk factors. This cross-sectional study was conducted on the data obtained from the IFLS in 2014. The IFLS data pertaining to toothache and its prevalence were analysed using the STATA software, and the multifaceted relationship was analysed using SEM. The prevalence of toothache among Indonesian children was 15.55% (1,959 of 12,595). SEM showed the direct association between toothache and age (p p p p

The integration of oral health into primary health care denotes the important role of medical counterparts as the front liners in antenatal care to help screen mothers for oral symptoms and refer them to dentists accordingly. However, the validity of self-perceived oral health status is inconclusive. This study determined the association between self-perceived oral symptoms and the presence of clinically diagnosed oral diseases in a sample of pregnant women. A total of 192 pregnant women participated in this cross-sectional study. Clinical oral examinations were performed to record dental caries experience, gingival health and periodontal health. The women were also asked about their oral symptoms. Most women had at least one oral symptom (84.9%): cavitated tooth (62.0%), bad breath (38.5%), bleeding gums (28.6%), and toothache (22.9%). About half of the women had untreated dental caries (58.9%), and the odds were significantly higher in women who complained of having cavitated tooth. About half of the women had moderate to severe gingivitis (53.7%), and the odds were significantly higher in women who complained of bleeding gums. About half had periodontal pockets (46.3%), and the odds were higher in women who complained of bleeding gums and bad breath although lower in women who complained of swollen gums. In conclusion, the prevalence of dental caries and periodontal disease among pregnant women in this study were relatively high. The presence of untreated dental caries, moderate and severe gingivitis, and periodontal pockets were significantly associated with their corresponding oral symptoms.

The objective of the research was to determine odontological (odontometric and odontoscopic) and morpho-aesthetic variations of the upper central and lateral incisors in 14-year-old children residing in Udmurt Republic. 200 adolescent respondents (100 boys and 100 girls) were included in the study. We accessed morphological aspects of the permanent upper right and left central incisors (URCI and ULCI) in 14-year-old children born and permanently residing in conditionally ecologically favorable districts of the Udmurt Republic. Odontological variations of the permanent tooth crown shapes in early adolescent children (14-year-old) are shown; morphological, ethnic, age and gender, aesthetic features are determined. The determined odontoscopic and odontometric features of the permanent tooth crown shapes matter of scientific and practical terms and can be used to clarify ethnicity and possibly gender. The identified patterns can change and multiply the information-statistical interpretation of the ethnic and morpho-aesthetic features of the permanent teeth, and hence have an important impact when restoring damaged teeth crowns, which affect the permanent dentition smile harmony in 14-year-old adolescents born and permanently residing in the Udmurt Republic.Установление одонтологических (одонтометрических и одонтоскопических) и морфолого-эстетических особенностей верхних центральных и боковых резцов у детей в возрасте 14 лет, проживающих в Удмуртской Республике.В исследование вошли 200 респондентов-подростков (100 мальчиков и 100 девочек). Проведена оценка морфологических показателей параметров верхних правых и левых центральных резцов (ВПМР и ВЛМР) в постоянном прикусе у детей 14 лет, родившихся и постоянно проживающих в условно благоприятных в экологическом плане районах Удмуртской Республики.Показаны одонтологические вариации форм коронок зубов в постоянном прикусе у детей раннего подросткового возраста, определены морфологические, этнические, возрастно-половые, эстетические особенности.

This study aimed to examine 20-year trends (1994&ndash, 2014) in self-reported oral health and oral hygiene and to assess the associated factors in a Lithuanian population aged 20&ndash, 64 years. Nationally representative cross-sectional data on 8612 men and 11,719 women were obtained from 11 biennial postal surveys of Lithuanian health behavior monitoring. Dentate status was assessed by asking about the number of missing teeth. Over the study period, the proportion of men with all teeth increased from 17.5% to 23.0% and the same proportion increased in women&mdash, from 12.5% to 19.6%. The prevalence of edentulousness was 2.8% in 2014. The proportion of individuals brushing teeth at least twice a day increased from 14.6% to 31.9% in men and from 33.0% to 58.8% in women. Multivariate logistic regression analysis revealed that older age, lower education, living in rural areas, daily smoking, confectionary consumption (only in women), obesity, no visits to a dentist during the past year, toothache and brushing teeth less than twice a day increased the odds of missing six or more teeth. Efforts should be made to promote good oral hygiene habits, prevent and control behavioral risk factors and increase access to dental care among risk groups.

This study examined the effects of delivery mode on the response to inflammatory pulpal pain and pain-induced changes in cognitive performance in adult rats. Experiments were done on rats born by vaginal or caesarean section (C-section) delivery. Dental pulp was irritated by intradental capsaicin (100 μg) application and then nociceptive scores were recorded for 40 min. Spatial and passive avoidance learning and memory were assessed using the Morris water maze (MWM) and shuttle box tools, respectively. Additionally, in vivo recording of field excitatory postsynaptic potential (fEPSP) in the CA1 of the hippocampus was used to verify synaptic plasticity. Capsaicin produced more significant nociceptive behavior in vaginally delivered rats compared to C-section rats (P < 0.01). C-section-delivered rats show better performance in both MWM and shuttle box tests. Likewise, C-section rats had greater fEPSP slopes compared to the vaginally delivered group (P < 0.05). Capsaicin impairs cognitive performance in rats born by each delivery route. However, capsaicin effects were more significant in rats delivered vaginally than by C-section. Overall, C-section-delivered rats show lower sensitivity to capsaicin-evoked pulpal nociception and better cognitive performance than vaginally delivered rats. These effects are in part mediated by reduced neuroinflammation and enhanced neuronal synaptic plasticity following C-section delivery.

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.

Background. Dental caries is one of the most common chronic diseases observed in elderly patients. The development of preventive strategies for dental caries in elderly individuals is vital. Objective. The objective of the present study was to construct a generalized regression neural network (GRNN) prediction model for the risk assessment of dental caries among the geriatric residents of Liaoning, China. Methods. A stratified equal-capacity random sampling method was used to randomly select 1144 elderly (65-74 years) residents (gender ratio 1 : 1) of Liaoning, China. Data for the oral assessment, including caries characteristics, and questionnaire survey from each participant were collected. Multivariate logistic regression analysis was then performed to identify the independent predictors. GRNN was applied to establish a prediction model for dental caries. The accuracy of the unconditional logistic regression and the GRNN early warning model was compared. Results. A total of 1144 patients fulfilled the requirements and completed the questionnaires. The caries rate was 68.5%, and the main associated factors were toothache history, residence area, smoking, and drinking. We randomly divided the data for the 1144 participants into a training set (915 cases) and a test set (229 cases). The optimal smoothing factor was 0.7, and the area under the receiver operating characteristic curve for the GRNN model was 0.626 (95% confidence interval, 0.544 to 0.708), with a P value of 0.002. In terms of consistency, sensitivity, and specificity, the GRNN model was better than the traditional unconditional multivariate logistic regression model. Conclusion. Geriatric (65-74 years) residents of Liaoning, China, have a high rate of dental caries. Residents with a history of toothache and smoking habits are more susceptible to the disease. The GRNN early warning model is an accurate and meaningful tool for screening, early diagnosis, and treatment planning for geriatric individuals with a high risk of caries.

Introduction: Self-medication means the use of medications for the treatment of any disease on their own, without consulting any healthcare professional. At times self-medication can be useful if practiced correctly by saving time and money, whereas disadvantages often occur due to lack of evaluation by trained medical professionals and delay ineffective treatment and can result in unnecessary expenses and drug dependence. This study was conducted to find out the self-medication behavior and its associated factors among patients visiting a dental hospital in Kathmandu. Methods: A hospital-based, cross-sectional study was conducted on 265 patients in Kantipur Dental College from December 2019 to January 2020 among the patients attending the dental Out Patient Department. Ethical clearance was obtained from the Institutional Review Committee of Kantipur Dental College. A convenience sampling technique was used. Proformas were prepared in English, translated to Nepali and re-translated to English by the back-translation method. Data entry was done in Microsoft Excel and analysis in SPSS 20. Descriptive statistics was done. Results: The prevalence of self-medication practice was found to be 166 (62.6%). Out of total participants, 99 (59.6%) consumed medicines for few days only and the most common triggering factor was found to be toothache in 101 (60.8%) participants. The most common reason for self-medication was found to be a previous experience of treating similar illnesses. Conclusions: The prevalence of self-medication was found to be low as compared to the study done in similar settings. Self-medication practice is a sensitive issue that hasn't been given the required consideration. It is of concern to find every other dental patient being indulged in self-medication whether in the present or the past.

Design This study investigates the influence of socioeconomic inequalities on Brazilian adolescents' oral health-related quality of life (OHRQoL) as measured by the Child Perceptions Questionnaire for 11- to 14-year-old children (CPQ11-14) over time using a cohort study design.Cohort Selection The initial 1,134 participants for this study were recruited using two stage random sampling. Of these, 747 remained at the two-year follow-up.Data Analysis Multi-level linear regression was performed on socioeconomic factors, clinical variables, and CPQ11-14 scores at the two timepoints.Results Lower school neighbourhood and household income, and maternal education are associated with worse OHRQoL over time in adolescents. Other predictors shown to be associated with worse OHRQoL over time include being female, having been seen by a dentist for toothache, having caries and having malocclusion.Conclusions Adolescents from lower socioeconomic backgrounds are more likely to have worse OHRQoL over time than their peers from high socioeconomic groups. Other factors shown to be associated with worse OHRQoL over time include being female, having been seen by a dentist for toothache, having caries and having malocclusion.

Background: Infections of facial spaces in the maxillofacial region occur in most cases as a complication of odontogenic infections. It often results in substantial morbidity, with serious and potentially life threatening outcomes if allowed to progress without prompt medical attention.Objective: To identify factors that determine illness behaviour related to maxillofacial space infections.Method: This was a descriptive cross-sectional study of adult residents of pakoto community, Ifo local government area, Ogun state. The study was conducted using an interviewer administered questionnaire which included key information about respondents’ awareness of predisposing factors of maxillofacial space infections; common actions takenwith regards to treatment, and the factors that influenced their utilization of the available oral health care service.Results: A total of 187 individuals were sampled, mean age was 30.5(SD 11.7) years with majority being females (59.4%) The proportion of the total respondents who reported a history suggestive of orofacial space infection was 20.3% (n=38). Visiting a patent medicine dealer (26.3%) along with visiting a dentist (31.6%) were the illness behaviours most frequently engaged in by respondents who have had an orofacial swelling following a toothache, with majority (73.7%) indicating the action they took was based on what was most convenient.Conclusion: This study has revealed that engagement in unorthodox practises by individuals in a semi-urban community studied is prevalent, and influenced by factors such as age, gender, level of education and occupation.Keywords: Odontogenic infection, semi-urban community, illness behaviourFunding: None