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Background: Oxidative stress indicators affect chronic orofacial pain (COFP), but how to reduce these effects is uncertain. Objectives: 11 oxidative stress biomarkers were collected as exposures, while four forms of COFP were chosen as outcomes for Mendelian randomization (MR) study. Methods: The effect estimates between oxidative stress and COFP were calculated using inverse variance‐weighted MR (IVW‐MR). Then, functional mapping and annotation (FUMA) was utilized in order to carry out SNP‐based functional enrichment analyses. In addition, the IVW‐MR method was applied to combine effect estimates when using genetic variants associated with oxidative stress biomarkers as an instrument for exploring potential druggable targets. Results: The results indicated that oxidative stress biomarkers (causal OR of uric acid (UA), 0.998 for myofascial pain, 95% CI 0.996–1.000, p <.05; and OR of glutathione transferase (GST), 1.002 for dentoalveolar pain, 95% CI 1.000–1.003, p <.05) were significantly linked with the probability of COFP. Functional analysis also demonstrated that UA and myofascial pain genes were prominent in nitrogen and uracil metabolism, while GST and dentoalveolar pain genes were enriched in glutathione metabolism. Also, the study provided evidence that solute carrier family 2 member 9 (SLC2A9) and glutathione S‐transferase alpha 2 (GSTA2) cause discomfort in the myofascial pain (OR = 1.003, 95% CI 1.000–1.006; p <.05) and dentoalveolar region (OR = 1.001, 95% CI 1.000–1.002; p <.05), respectively. Conclusions: In conclusion, this MR study indicates that genetically predicted myofascial pain was significantly associated with decreased UA and dentoalveolar pain was significantly associated with increased GST level. SLC2A9 inhibitor and GSTA2 inhibitor were novel chronic orofacial pain therapies and biomarkers, but clinical trials are called to examine if these oxidative biomarkers have the protective effect against orofacial pain, and further research are needed to explore the underlying mechanisms. [ABSTRACT FROM AUTHOR]

An in-depth understanding of the anatomical variations of maxillary molars is essential for endodontic success. Unlike the maxillary second molars, the presence of a second palatal root is uncommon in the first maxillary molar. This case report describes two cases of non-surgical management of maxillary molars with extra palatal roots. Careful clinical examination, knowledge of the internal anatomy, and the use of advanced radiographic modalities like cone beam computed tomography (CBCT) can reveal the presence of variations in the internal and external anatomy of any tooth. Therefore, for nonsurgical as well as surgical management clinicians should always watch out for any deviations in a tooth and utilize all the available tools to diagnose and manage them successfully. [ABSTRACT FROM AUTHOR]

Purpose: To investigate if facial and dental satisfaction is related to body fat percentage and body weight satisfaction. Methods: A self-administered questionnaire was applied to adolescents from a Private School in Southern Brazil containing sociodemographic (sex and age) and self-perception variables. Adolescents were asked about their perceptions concerning dental problems. Body fat percentage was collected using bioelectrical impedance analysis. Results: A total of 372 adolescents were examined. Most adolescents were satisfied with their dental (81.7%) and facial appearance (87.6%), while 39% of adolescents were satisfied with their body weight. Poisson regression model showed that adolescents who expressed satisfaction with their body weight (PR = 1.12, 95%CI 1.06–1.19) and were satisfied with their dental appearance (PR = 1.24, 95% CI 1.08–1.41) exhibited a positive association with facial satisfaction. Adolescents dissatisfied with dental color (PR = 0.88, 95%CI 0.80–0.97), those reporting dental pain (PR = 0.88, 95%CI 0.80–0.97), and individuals with obesity (PR = 0.91, 95%CI 0.83–0.99) demonstrated a decrease in facial satisfaction. Adolescents aged 16 to 19 years (PR = 1.08, 95% CI 1.01–1.15) and those satisfied with their facial appearance (PR = 1.20, 95%CI 1.01–1.43) exhibited a higher prevalence of dental satisfaction. Conversely, adolescents dissatisfied with dental color (PR = 0.74, 95% CI 0.66–0.82) and those with misaligned teeth (PR = 0.63, 95%CI 0.55–0.73) reported lower levels of dental satisfaction. Parametric g-formula analysis found that the association between body fat and facial satisfaction was mediated by body weight satisfaction (p = 0.001). Conclusions: While dental satisfaction was not influenced by corporeal characteristics, facial satisfaction was influenced by dental and body weight satisfaction. Obese adolescents had low facial satisfaction. [ABSTRACT FROM AUTHOR]

Neuropathy of the inferior alveolar nerve in recent years is one of the most common complications after dental interventions, accompanied by severe pain and sensitivity disorders. Clinically, iatrogenic neuropathy of the trigeminal nerve is represented, as a rule, by the presence of constant aching, burning or dull pain in the area of innervation of the affected nerve, against which neuralgic paroxysms occur with irradiation of pain, respectively, to the segmental areas of the face. The autonomic nervous system is often involved in the process. Unfortunately, at present there is no uniform treatment protocol for this pathology. As is known, botulinum toxin type A has a direct effect on pain afferents and an analgesic effect when administered locally into areas of sensitivity disorder. The aim of study to analyze the effectiveness of treatment methods for patients with iatrogenic neuropathy of the inferior alveolar nerve after surgical intervention using botulinum toxin type A. 70 patients took part in the study. For a comparative assessment of the effectiveness of treatment, they were divided into two groups: group 1 - patients who received conservative drug treatment; group 2 - conservative drug treatment in combination with botulinum therapy. Dynamic observation and evaluation of the effectiveness of treatment were carried out before the start of treatment, after 3 and 6 months. A comparative analysis of the effectiveness showed that the method of complex therapy using injections of botulinum toxin type A in group 2 demonstrated more pronounced positive dynamics than in patients of group 1. The results of our studies confirmed that botulinum therapy is a modern clinically proven method for relieving pain and sensory disorders in neuropathy. [ABSTRACT FROM AUTHOR]

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Objective: To know the information available in bibliographic sources about dental pain and its associated factors in Brazilian Indigenous individuals. Material and Methods: Critical review in which a literature search was conducted in the databases: BVS encompassing LILACS, MEDLINE and also PubMed and Scielo. Descriptors in Portuguese and English were used, and the Boolean operator “AND” was used to cross the information. Results: After completing literature searches in the databases and other sources the authors obtained 285 articles, and after exclusion of duplicate journals and articles whose titles, abstracts and texts were not related to the researched subject, 02 articles were included in the review. Conclusion: There are few studies on the topic researched, which highlights the need to develop more research in this area to enable comparisons and obtain the best scientific evidence on the researched topic. The Indigenous adult and adolescent population, when compared to the general population, showed a higher percentage of people with toothache that was associated with poor self-perception of oral health.

Abstract Background and aim Self‐medication is a common practice worldwide, and its prevalence ranges between 20% and 80% among patients suffering from dental pain. The socioeconomic status of an individual plays a key role in self‐medication practice, especially sex and education level. This study aims to investigate the extent of self‐medication practice for toothache due to dental caries among adults in Dar es Salaam, Tanzania. Methods This was an analytical cross‐sectional study carried out over 6 months. It included adult patients presenting with toothache in public dental clinics. A questionnaire captured information on demography, self‐medication practice, the substance used for self‐medication, duration of self‐medication, and reason for self‐medication. Univariate analysis was carried out to assess factors associated with self‐care remedies. The probability level of α

As burning mouth syndrome (BMS) and atypical odontalgia (AO) continue to remain complex in terms of pathophysiology and lack explicit treatment protocol, clinicians are left searching for appropriate solutions. Oversimplification solves nothing about what bothers us in clinical situations with BMS or AO. It is important to treat a complicated phenomenon as complex. We should keep careful observations and fact-finding based on a pragmatic approach toward drug selection and prescription with regular follow-up. We also need to assess the long-term prognosis of treatment with a meticulous selection of sample size and characteristics. Further investigation of BMS and AO from a psychosomatic perspective has the potential to provide new insight into the interface between brain function and "chronic orofacial pain." [ABSTRACT FROM AUTHOR]

Background: Treating the coronal dens invaginatus (CDI) with pulp infection commonly involves the removal of invagination, which increases the risk of perforation and fracture, and compromises the tooth structure. Minimally invasive endodontic management of CDI is highly recommended. This report describes two cases of type II CDI with the application of personalized templates. Case presentation: Two cases of type II CDI, affecting the main root canal in a maxillary canine and a lateral incisor, were diagnosed. A guided endodontics (GE) approach was applied. Cone-beam computed tomography and intraoral scans were imported and aligned in a virtual planning software to design debridement routes and templates. The MICRO principle (which involves the aspects of Mechanical (M) debridement, Irrigation (I), Access cavities (C), Rectilinear routes (R), and Obstruction (O)) was proposed for designing optimal debridement routes for future applications. The templates were innovatively personalized and designed to preserve the tooth structure maximally while effectively debriding the root canal. Root canal treatment with supplementary disinfection was then performed. The follow-up of the two patients revealed favorable clinical and radiographic outcomes. Conclusions: The GE approach could be a feasible method for preserving healthy dental structure while effectively debriding the root canal, thereby achieving successful and minimally invasive endodontic treatment for CDI. [ABSTRACT FROM AUTHOR]

Background: A change in professionals' perspectives on the value of general anesthesia (GA) for pediatric patients, including those with disabilities, medical conditions, severe oral issues, and challenging behaviors. Full-mouth rehabilitation under GA allows for the comprehensive treatment of all oral health problems in a single visit, without requiring the child's active participation. Extensive dental problems are often associated with severe dental pain, which can impact cognitive function, including perception, attention, memory, reasoning, language, communication, and executive functions. Individuals experiencing pain tend to perform less optimally cognitively. Aim: This study aimed to investigate changes in cognition, brain function, and cortical alterations in children who underwent extensive dental rehabilitation under GA. Patients andMethods: Thirty uncooperative, healthy children aged 6–12 with extensive dental issues were enrolled. Pain levels were assessed using the FLACC and WBFPS scales before treatment, one week after, and three months later. Cognitive assessments, including the WCST, processing speed, digit span, and Trail Making Test, as well as EEG measurements, were also performed. Results: The results showed a significant improvement in pain levels reported by the children or their caregivers after the dental procedures, both at one week and three months. All cognitive measures, such as digit span, processing speed, and WCST performance, demonstrated substantial improvements after the treatment. The Trail Making Test also exhibited statistically significant variations before and after the dental procedures. Additionally, the MOCA test revealed a notable improvement in cognitive skills following the treatment. Furthermore, the EEG power ratio, an indicator of changes in the power balance within each frequency band, showed a statistically significant difference after the dental procedures. Conclusion: the findings of this study suggest that full-mouth rehabilitation under GA can lead to improved pain management, as well as enhanced cognitive and brain functions in children. Future perspectives: More clinical studies with a longer follow-up period and a different age range of children are required to investigate the connection between brain function and oral rehabilitation involving restorations or occlusion issues. [ABSTRACT FROM AUTHOR]

Cimicifugae Rhizoma, generally known as "Sheng Ma" in China, has great medicinal and dietary values. Cimicifugae Rhizoma is the dried rhizome of Cimicifuga foetida L., Cimicifuga dahurica (Turcz.) Maxim. and Cimicifuga heracleifolia Kom., which has been used to treat wind-heat headache, tooth pain, aphtha, sore throat, prolapse of anus and uterine prolapse in traditional Chinese medicine. This review systematically presents the traditional uses, phytochemistry, pharmacology, clinical studies, quality control and toxicity of Cimicifugae Rhizoma in order to propose scientific evidence for its rational utilization and product development. Herein, 348 compounds isolated or identified from the herb are summarized in this review, mainly including triterpenoid saponins, phenylpropanoids, chromones, alkaloids, terpenoids and flavonoids. The crude extracts and its constituents had various pharmacological properties such as anti-inflammatory, antitumor, antiviral, antioxidant, neuroprotective, anti-osteoporosis and relieving menopausal symptoms. The recent research progress of Cimicifugae Rhizoma in ethnopharmacology, phytochemistry and pharmacological effects demonstrates the effectiveness of its utilization and supplies valuable guidance for further research. This review will provide a basis for the future development and utilization of Cimicifugae Rhizoma. [ABSTRACT FROM AUTHOR]

To address the need for faster pain relief of over-the-counter (OTC) analgesic users, a novel drug delivery technology was developed to achieve faster absorption of orally administered acetaminophen with the goal of delivering earlier onset of pain relief. Previous development studies suggested that a 1000 mg dose of this fast-acting acetaminophen (FA-acetaminophen) formulation provided faster absorption and onset of action versus, commercially available OTC fast-acting analgesics, 1000 mg of extra-strength acetaminophen (ES-acetaminophen) or 400 mg of liquid-filled ibuprofen capsules (LG-ibuprofen). This study was designed as the definitive trial evaluating the onset of pain relief of FA-acetaminophen versus these same OTC comparators. This single-dose, randomized, double-blind, placebo- and active-controlled clinical trial compared analgesic onset, overall efficacy, and safety of FA-acetaminophen 1000 mg, ES-acetaminophen 1000 mg, LG-ibuprofen 400 mg, and placebo over 4 h in a postsurgical dental pain model. Following removal of 3 to 4 impacted third molars, 664 subjects with moderate-to-severe pain were randomized in a 4:4:2:1 ratio to FA-acetaminophen (249), ES-acetaminophen (232), LG-ibuprofen (124), or placebo (59). Mean age was 18.9 years; 45.5% were male; 57.5% had severe baseline pain intensity. Subjects stopped a first stopwatch if/when they had perceptible pain relief and a second stopwatch if/when their pain relief became meaningful to them. Pain intensity difference (PID) and pain relief (PAR) were obtained using an 11-point numerical rating scale. FA-acetaminophen 1000 mg had faster median time to onset of pain relief (15.7 min) compared to ES-acetaminophen 1000 mg (20.2 min, p = 0.035), LG-ibuprofen 400 mg (23.2 min, p < 0.001), and placebo (non-estimable), statistically greater mean PAR and PID scores than other treatment groups at 15 and 30 min, and a statistically greater percentage of subjects with confirmed perceptible pain relief at 15 and 20 min. At 25 min, FA-acetaminophen 1000 mg had a statistically significantly greater percentage of subjects with confirmed perceptible pain relief than LG-ibuprofen 400 mg and placebo. No clinically significant adverse events were reported. This study supports previous studies, demonstrating faster onset of analgesia with FA-acetaminophen 1000 mg compared to OTC ES-acetaminophen 1000 mg and OTC LG-ibuprofen 400 mg. NCT03224403 [ABSTRACT FROM AUTHOR]

Summary: Background: Equine odontoclastic tooth resorption and hypercementosis (EOTRH) is being increasingly recognised as a painful and debilitating condition in some affected horses, that can produce pain on prehension or result in infected, fractured and loose incisors. The only known way to completely alleviate the pain and secondary infection associated in many horses affected with EOTRH is by extraction of the diseased incisors. Currently, few large‐scale clinical outcome studies have been performed. Objectives: The purpose of this study was to determine if horses that are diagnosed with clinical EOTRH experience a statistically significant improvement in the quality of their lives after surgical extraction of all incisors and to determine if owners were satisfied with the results of the surgery. Study design: A retrospective web‐based survey was sent out to owners of horses diagnosed with EOTRH who had undergone extraction of all incisors in the previous 3 years. Methods: Forty‐eight surveys were completed, and the answers examined for statistical significance. Results: Statistically significant differences were found in the horses' body condition, dropping of hay, speed of eating, general behaviour, resistance to bridling and headshaking. In addition, owners reported that horses were 'happier' after surgery and that total extraction improved quality and extended the life of their horse. Over 90% of owners would also elect to have the procedure performed on another horse in the future. Main limitations: Retrospective surveys are prone to selection, recall and misclassification bias. Conclusions: Owners were highly satisfied with the total extraction of all incisors as a treatment for horses affected by EOTRH. Survey results showed that post‐extraction horses had improved body condition and exhibited better bridling and eating behaviours which are consistent with a decrease in dental pain. Owners felt that their horse was happier and that the surgery had improved the horse's quality of life. [ABSTRACT FROM AUTHOR]

Aim and objectives: A prospective split mouth study was done to compare the efficacy of transdermal ketoprofen versus diclofenac patch after therapeutic orthodontic tooth extraction based on four parameters – pain intensity (VAS), number of rescue analgesia intakes, local allergic reactions and patient tolerability for immediate and 3 consecutive postoperative days. Materials and methods: In total, 33 (66 extraction sites) patients were divided into the ketoprofen patch group and the diclofenac patch group. A single ketoprofen patch (70 cm2 30 mg) was applied following extraction of premolars of the 1st and 4th quadrants and patients were recalled after 1 week for extractions of premolars of the 2nd and 3rd quadrants and diclofenac patch (50 cm2 100 mg) was applied on the deltoid region of the right arm, respectively. Patients were then evaluated under the above‐mentioned parameters. Results: Ketoprofen transdermal patch was found to be more effective in terms of controlling postoperative pain and the minimum number of rescue analgesia tablets taken as compared to diclofenac (statistically significant on 1st and 2nd day) though the former showed the incidence of a local allergic reaction (p‐value 0.002, 0.002 and 0.012), respectively, in few cases which were not seen in case of diclofenac. Conclusion: Overall, both the transdermal patches are effective in terms of safety and providing analgesia, though more research are needed in proving the safeness and efficiency of these transdermal patches with large sample size. [ABSTRACT FROM AUTHOR]

Introduction: When the traditional incremental technique is used for direct placement of composite resin in a deep occlusal cavity, each increment (2 mm or thicker) is individually cured where it undergoes hardening and shrinkage. As increments are bonded to all cavity walls, a constrained shrinkage develops in tooth, composite, and/or interfaces. In the first composite increment, this constrained shrinkage generates tensile stresses which are distributed in a nonuniform pattern within that increment, resulting in premature stressing of the dentin bond of the hybrid layer at the pulpal floor before it reaches full maturation. This premature stressing leads to initiation of interfacial debonding and propagation to form a microgap. This behavior is associated with persistent postoperative sensitivity and tooth pain, over the time, which subsequently results in restoration failure. Aims: This paper provides a comprehensive review on the first composite increment and its dependency on placement technique for the interaction behavior with the maturing dentin‑adhesive bond at pulpal floors in deep occlusal cavities. Materials and Methods: The dental database was searched, and 59 articles were collected and included in this review, spanning the years from 1984 to 2023. Results and Discussion: Three biomimetic direct restorative techniques were reported in the literature for incrementally restoring large occlusal cavities. These techniques are the decoupling with time, the decoupling with fiber, and the decoupling with split‑increment. They all aim at minimizing the generated shrinkage stresses in the first composite increment for protecting the developing dentin bond of the hybrid layer until it reaches full maturation and thus preventing the initiation and propagation of interfacial defects at pulpal floors of deep occlusal cavities. Finally, the restoration is completed by placing and curing successive increments of 1.5 mm each to fill the cavity; their number depends on the cavity depth. These increments can each be cured immediately following placement. Conclusions: In deep occlusal cavities, the interaction behavior between the first composite increment and the maturing dentin‑adhesive bond at the pulpal floor depends on the technique used for the increment placement. This behavior is either favorable with the direct biomimetic techniques or unfavorable with the traditional incremental technique. With the direct biomimetic techniques, no premature shrinkage stressing of the dentin bond is induced at the pulpal floor. This prevents the initiation of interfacial debonding and propagation to form microgaps and results in the absence of postoperative sensitivity and persistent tooth pain. [ABSTRACT FROM AUTHOR]

Objectives: Oral health problem is prevalent in the elderly population which is also at high risk of Parkinson's disease (PD). However, the association between self-reported oral health and PD is still unclear. We aimed to explore the association between baseline self-reported oral health (mouth ulcers, painful gums, bleeding gums, loose teeth, toothache, dentures) and future incidence of PD. Methods and Participants: Participants were enrolled in the UK Biobank from 2006 to 2010 and those without PD at baseline were included in the current study. We used Cox regression analysis to explore the question and adjusted for age, sex, body mass index, smoking, drinking, ethnicity, education, socioeconomic status, and average total household income before tax. Results: We included 421,180 participants with a mean age of 56.26 years old, and 46.5% of them were male. And 2,339 participants were diagnosed with PD in the follow-up. Mouth ulcers, loose teeth, dentures, toothache, and bleeding gums were not related to the risk of PD. Painful gums were related to a higher risk of PD (HR: 1.39, 95% CI: 1.12–1.72, p = 0.003), and similar results were reached after adjusting for gene risk (HR: 1.39, 95% CI: 1.12–1.73, p = 0.003), or source of diagnosis (HR: 1.39, 95% CI: 1.12–1.72, p = 0.002), and time of diagnosis (HR: 1.29, 95% CI: 1.03–1.63, p = 0.02). Conclusions: Our study has demonstrated a substantial correlation between painful gums and elevated susceptibility to PD, underscoring the potential advantages of implementing oral health interventions for decreasing the risk of PD. [ABSTRACT FROM AUTHOR]

Oral health is situated within the framework of the global health agenda, addressing facets pertaining to well-being and quality of life. The research is based on the need to address variables at the community level to improve schoolchildren's oral health and promote healthy behaviors and aims to carry out an in-depth analysis from the perspective of the factors that influence children's oral health. Step 1, designed by the World Health Organization, was utilized. An easy-to-use web interface was created for data collection. The statistical analysis consisted of using multinomial and binominal logistic regression models. The level of education of the adult has a high probability of influencing the consumption of unhealthy or healthy foods, it has a significant probability of exerting influence on social or medical problems and a correlation was found between the level of academic education and the pattern of dental visits. The development of health-promoting behaviors begins in childhood and involves parents, who have an essential role in the education of their children. Oral health promotion programs in schools need to target the child–adult–teacher–dentist relationships. Taking into consideration the aforementioned, a threefold viewpoint is necessary for the development of a national program aimed at promoting the oral health of schoolchildren in Romania. [ABSTRACT FROM AUTHOR]

One of the most frequent problems that patients bring to a dental clinic is pain in the orofacial region or within the tooth. To identify and solve the issue, a proficient practitioner needs to be equipped with the necessary information and resources. Comprehending the history of pain control in dentistry can provide valuable understanding into the development of the present techniques. Newer and more effective pain management treatments have been created as dentistry continues to advance. Several modalities have been developed to reduce and eliminate this, including pharmacological and nonpharmacological treatment modalities. The goal of the present review of the literature's findings is to provide dentists with reliable information regarding the application of contemporary local anesthetics, alternative methods, and strategies to reduce pain during anesthesia administration, thereby improving patient comfort. [ABSTRACT FROM AUTHOR]

Background: Factitious disorder imposed on self (FDIS), also known as Munchausen's syndrome, is a psychological disorder characterized by falsification of physical or psychological symptoms without an obvious external incentive. Oral presentations of FDIS are infrequently reported, and diagnosis might be challenging because affected patients often have impressive skills in fabricating symptoms and deceiving healthcare professionals. Aim: To describe the diagnostic dilemma and management challenges in a female patient who presented with tooth ache and oral ulcers. Case Description: A 53‐year‐old female presented with complex medical history, vague symptoms and confusing dental history regarding persistent toothache and generalized oral ulcers. She underwent extensive investigations and multiple dental and oral surgical procedures without reaching a confirmed diagnosis or achieving symptomatic improvement. Thorough review of her medical records revealed multiple admissions to various hospitals across the country and abroad for various reasons, and failed to find any laboratory, clinical, or radiographic evidence of her "claimed" symptoms. Conclusion: Oral healthcare professionals should suspect FDIS in patients presenting with vague and complex history that is not explained by clinical or radiographic findings. Consultation with psychiatric department and hospital administration might be needed to confirm diagnosis and plan appropriate management of the case. [ABSTRACT FROM AUTHOR]

Background: Dental caries is a disease which results in progressive destruction of the tooth and gradually leads to sensitivity or pain in that tooth, i.e., toothache the prevalence of which is about 49%–83% worldwide. There are various causes for orofacial pain, of which toothache is quite common. When severe, its unbearable and extremely disturbing for the patient, hence, considered as dental emergency. As per Ayurveda, Krimidanta has clinical features similar to dental caries. Various treatment procedures are mentioned to manage Krimidanta janya-shoola (pain due to dental caries), of which one is the topical placement of Koshna (warm) Hingu over the affected tooth. Materials and Methods: An interventional study was done for which patients were selected from the outpatient department and inpatient department of Shalakya Tantra and were randomly divided into two Groups A and B. Group A was asked to topically place Koshna Hingu (warm asafoetida) at the site of Krimidanta janya shoola three times a day for 3 days and Group B was advised to take paracetamol (acetaminophen) three times a day for 3 days. A total of 30 patients were enrolled in the study and all of them completed the treatment. Results and Conclusion: The study showed that both Hingu and tablet paracetamol were effective in managing the pain caused due to dental caries, although the results were slightly better for the group which was given Hingu topically. [ABSTRACT FROM AUTHOR]

Background: Mechanosensitive ion channel PIEZOs have been widely reported to involve inflammation and pain. This study aimed to clarify expression patterns of PIEZOs and their potential relations to irreversible pulpitis. Materials and methods: Normal pulp tissues (n = 29) from patients with impacted third molars and inflamed pulp tissues (n = 23) from patients with irreversible pulpitis were collected. Pain levels were assessed using a numerical rating scale. PIEZO expressions were measured using real-time PCR and then confirmed using GEO datasets GSE77459, immunoblot, and immunohistochemistry staining. Correlations of PIEZO mRNA expression with inflammatory markers, pain markers, or clinical pain levels were evaluated using Spearman's correlation analysis. Univariate analysis was conducted to analyze PIEZO expressions based on pain description and clinical examinations of cold test, percussion, palpation, and bite test. Results: Compared with normal pulp tissues, mRNA expression levels of PIEZO1 were significantly increased in inflamed pulp tissues, while PIEZO2 was significantly decreased, which was further confirmed in GSE77459 and on a protein and histological level. The positive correlation of the mRNA expression levels between PIEZO1 and inflammatory markers, as well as between PIEZO2 and pain markers, was verified. PIEZO2 expression was also positively correlated with pain levels. Besides, irreversible pulpitis patients who reported continuous pain and who detected a positive response to cold stimulus exhibited a higher expression level of PIEZO2 in the inflamed pulp tissues. By contrast, patients reporting pain duration of more than one week showed a higher expression level of PIEZO1. Conclusions: This study demonstrated the upregulation of PIEZO1 and the downregulation of PIEZO2 in irreversible pulpitis and revealed the potential relation of PIEZO1 and PIEZO2 to inflammation and pain. These findings suggested that PIEZOs might play critical roles in the progression of irreversible pulpitis and paved the way for further investigations aimed at novel therapies of irreversible pulpitis by targeting PIEZOs. [ABSTRACT FROM AUTHOR]

Background: Ghost cell odontogenic carcinoma (GCOC) is a rare malignancy characterized by the presence of ghost cells, preferably in the maxilla. Only slightly more than 50 case reports of GCOC have been documented to date. Due to the rarity of this tumor and its nonspecific clinical criteria, there is a heightened risk of misdiagnosis in clinical examination, imaging findings, and pathology interpretation. Case presentation: A 50-year-old male patient presented to the hospital due to experiencing pain in his lower front teeth while eating for the past 2 months. Upon examination, a red, hard, painless mass was found in his left lower jaw, measuring approximately 4.0 cm × 3.5 cm. Based on the malignant histological morphology of the tumor and the abundant red-stained keratinized material, the preoperative frozen section pathology misdiagnosed it as squamous cell carcinoma (SCC). The surgical resection specimen pathology via paraffin section revealed that the tumor was characterized by round-like epithelial islands within the fibrous interstitium, accompanied by a large number of ghost cells and some dysplastic dentin with infiltrative growth. The malignant components displayed marked heterogeneity and mitotic activity. Additionally, a calcified cystic tumor component of odontogenic origin was observed. Hemorrhage, necrosis, and calcifications were present, with a foreign body reaction around ghost cells. Immunoreactivity for β-catenin showed strong nuclear positivity in tumor cells, while immunostaining was completely negative for p53. The Ki67 proliferation index was approximately 30–40%. The tumor cells exhibited diffuse CK5/6, p63, and p40 immunoreactivity, with varying immunopositivity for EMA. Furthermore, no BRAFV600E mutation was identified by ARMS-PCR. The final pathology confirmed that the tumor was a mandible GCOC. Conclusion: We have reported and summarized for the first time the specific manifestations of GCOC in frozen section pathology and possible pitfalls in misdiagnosis. We also reviewed and summarized the etiology, pathological features, molecular characteristics, differential diagnosis, imaging features, and current main treatment options for GCOC. Due to its rarity, the diagnosis and treatment of this disease still face certain challenges. A correct understanding of the pathological morphology of GCOC, distinguishing the ghost cells and the secondary stromal reaction around them, is crucial for reducing misdiagnosis rates. [ABSTRACT FROM AUTHOR]

Somatosensory innervation of the oral cavity enables the detection of a range of environmental stimuli including minute and noxious mechanical forces. The trigeminal sensory neurons underlie sensation originating from the tooth. Prior work has provided important physiological and molecular characterization of dental pulp sensory innervation. Clinical dental experiences have informed our conception of the consequence of activating these neurons. However, the biological role of sensory innervation within the tooth is yet to be defined. Recent transcriptomic data, combined with mouse genetic tools, have the capacity to provide important cell-type resolution for the physiological and behavioral function of pulp-innervating sensory neurons. Importantly, these tools can be applied to determine the neuronal origin of acute dental pain that coincides with tooth damage as well as pain stemming from tissue inflammation (i.e., pulpitis) toward developing treatment strategies aimed at relieving these distinct forms of pain. [ABSTRACT FROM AUTHOR]

Endodontic pain is a disruptive event to all clinicians and patients. When performing dental treatment on teeth with clinically healthy pulps, efficient and adequate local anesthesia is the fundamental basis for dental pain control. Nevertheless, when managing patients with acutely inflamed pulps, local anesthesia is actually much less efficient. Clinical trials have reported that an IANB injection of a local anesthetic solution is inefficient in 30 to 80% of patients diagnosed with acute irreversible pulpitis. Therefore, pain management of lower molars with symptomatic irreversible pulpitis is usually a challenge to the endodontist. Many efforts have been made to implement various pharmaceutical and non-pharmaceutical agents to control the inflammatory processes leading to pulpal pain. These agents chiefly included NSAIDs and synthetic steroids, along with other modalities such as cryotherapy and acupuncture. The effect of steroids and cryotherapy on the success rates on IANBs when treating lower molars with symptomatic acute pulpitis was investigated in a few studies to increase the efficiency and duration of nerve block in these cases. The goal of this review is to highlight the role of steroids and cryotherapy in increasing the success rate of IANB and to point out the clinical studies concerned with both modalities. [ABSTRACT FROM AUTHOR]

Objectives: To determine the incidence of neuropathic pain after endodontic treatment with follow-up at 6 months. Materials and Methods: This was a prospective observational clinical study that was carried out on patients who underwent endodontic treatment or retreatment carried out in the Master of Endodontics at the International University of Catalonia (UIC) from January 2022 to December 2022. After the treatment, a six-month follow-up was carried out, determining the presence of persistent pain, and whether the cause was of non-odontogenic origin, through anamnesis and physical examination carried out in the Department of Craniomandibular Dysfunction and Orofacial Pain of the Faculty of Dentistry. Results: A total of 231 treatments were obtained, obtaining a 53% response via telephone call. A descriptive analysis of the results was done, there were 88 patients who did not present pain after 6 months of endodontic treatment (72%); while 35 patients reported pain (28%). 9% of the cases with pain were caused by endodontic failure, in 74% the cause was due to involvement of another tooth and 11% due to periodontal reasons. It was estimated that 1.5% of treated patients had failed endodontic treatments at 6 months of follow-up. The causes of persistent pain were periodontal problems, such as food packaging, dentin hypersensitivity or pulpal origin associated with another tooth. Conclusions: After 6 months of follow-up, no patient presented neuropathic origin pain. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate patients' knowledge and perceptions of the use of systemic antibiotics in the treatment of endodontic infections and to determine the possible contribution of patients to the development of bacterial resistance. Methods: A total of 550 patients were asked to respond to a survey on the perception of systemic antibiotic use in the treatment of endodontic infections and antibiotic resistance during January 2022 and March 2023. A bivariate and multivariate analysis was performed to determine possible correlates in the population regarding antibiotic use in the endodontic world. Results: A total of 514 patients were included in the study, 65.9% of whom were women. While 34.6% of the population studied thought that it was always necessary to take antibiotics prior to endodontics, 49.4% considered that they were necessary after endodontics, regardless of the clinical symptoms. The prevalence of self-medication was 17.3%, and women self-medicate more than men, with significant differences (p < 0.05), although they have a greater knowledge of antibiotic resistance than men (p < 0.05). Forty-four percent of the population expected to take antibiotics when faced with dental pain, mainly women (p < 0.05). Conclusions: The general population is contributing to the serious problem of bacterial resistance. It is necessary to promote educational strategies focused on the correct use of antibiotics in the community. The worst results were found mainly in the population with a low level of education. The level of education was the variable that most influenced the knowledge and attitudes of the population, followed by the sex of the participants. [ABSTRACT FROM AUTHOR]

Peri-apical infection is a prevalent form of odontogenic infection, typically following the path of least resistance through cancellous bone towards the cortical plate. This infection begins as cellulitis and may progress to an abscess, sometimes involving various anatomically potential spaces. While frontal space infection is a rare complication of odontogenic infection spread, it can occur in conjunction with buccal space, sub-mental space, and orbital space involvement. In this report, we present the case of a 62-year-old man with a history of tooth pain and diabetes mellitus for the past decade. The patient exhibited symptoms of swelling, multiple draining sinuses, pain, proptosis, and fever. Prompt action was taken to drain the multiple abscesses, and the causative teeth were subsequently extracted. This case illustrates one of the severe complications associated with odontogenic infection, which has the potential to be life-threatening. [ABSTRACT FROM AUTHOR]

Dental caries is one of the common preventable diseases. And it is amongst the primary causes of oral pain and tooth loss. Fluoride is reported as an effective and safe agent in the prevention and control of dental caries. Therefore, today many products such as gel, varnish, toothpaste, and restorative materials contain fluoride ions, and restorative materials that can release fluoride are preferred in dental treatments. Today, there are many fluoride-containing restorative materials, including glass ionomer cements, compomers, glass carbomers, giomers, and fluoride-containing composite resins. When the studies are examined, there are many studies on the fluoride release of the restorative materials that release fluoride on the discs, and there are a limited number of studies on the ion releases other than fluoride on the teeth. Therefore, in this study, it was aimed to investigate the ion release of various restorative materials that release fluoride to primary teeth in vitro. In the study, Ionofil U (cgic), Dyract XP (compomer), EQUIA Fil (glass hybrid), SDR plus U (composite) and Beautifil-Bulk (giomer) materials were used. The ion release concentrations of the materials in the primary teeth on the 1st, 14th and 35th days were evaluated in the SEM device in the EDAX TEAM program. As a result of this research, amongst the restorative materials used, the highest average fluoride release value was determined in the glass ionomer group, followed by glass hybrid restorative material, compomer, giomer and bulk flow composite material, and in line with these findings, higher fluoride release and the decrease in fluoride release over time were found to be other. It has been predicted that glass ionomer cements and glass hybrid restorative materials may be appropriate, especially in patients with high caries risk, because they are less than other materials [ABSTRACT FROM AUTHOR]

The study aimed to test the validity and reliability of the Romanian version of short form of Fear of Dental Pain questionnaire (s-FDPQ), modified by adding an item about dental implant insertion. Material and methods: The design of the study was cross-sectional. Data were collected through an online questionnaire completed by university students, administered from January to March 2024. The survey included information about past dental treatments, the Dental Anxiety Scale (DAS), and items of s-FDPQ. Results: 186 participants were included in the study. The Romanian version of the modified s-FDPQ had a good reliability Sperman-Brown coefficient is 0.878, and Cronbach alpha is 0.92. The questionnaire had a good convergent validity, with all items being moderately correlated with the DAS score. The one-factor model was tested and has a good fit according to the confirmatory factor analysis. The participants were afraid of pain mostly regarding having a wisdom tooth extracted or a dental implant inserted. A statistically significant higher fear of dental pain was observed in those who did not previously have a root canal treatment (p=0.008) and in those who had dental implants in the past (p=0.046). Those attending regular dental checkups had lower levels of fear of dental pain. Conclusion: The Romanian version of s-FDPQ, modified by adding a question about dental implant insertion, has good reliability and validity. Fear of dental pain seemed to be influenced by features of dental procedures and previous dental experience. [ABSTRACT FROM AUTHOR]

Objective: To investigate the perception of parents or caregivers regarding the need for dental appointments for adolescents aged 12–13 years and associated factors. Methods: Data from the Pelotas 2004 Birth Cohort were used. The outcome variable was the need for dental appointments for young adolescents perceived by parents or caregivers. Demographic and economic exposure variables were obtained from the first (2004) and sixth general follow‐up (2015), respectively. The exposure variables 'previous history of dental pain', 'self‐rated oral health', clinical variables and the outcome variable were obtained from the second oral health follow‐up (2017). Unadjusted and adjusted multivariate Poisson regression analyses provided prevalence ratios (PR) and respective 95% confidence intervals (CI). Results: At the first oral health follow‐up (2009), 1303 five‐year‐old children were recruited, 996 of whom were reassessed and underwent oral health examinations at 12 and 13 years of age (response rate: 76.4%). The findings showed that 72.4% of parents/caregivers perceived that the adolescents needed dental appointments. No associations were found between the outcome and sociodemographic or economic variables. After adjustments, the outcome remained positively associated with previous history of toothache (PR 1.22; 95% CI 1.14–1.32), self‐rated oral health as fair or poor (PR 1.26; 95% CI 1.15–1.39), the presence of dental caries (PR 1.27; 95% CI 1.20–1.38) and severe or disabling malocclusion (PR 1.14; 95% CI 1.05–1.25). Conclusions: The perception of parents/caregivers regarding the need for dental appointments on the part of their adolescent sons and daughters was associated with oral health problems, and these findings can serve as the basis for creating and improving oral health programmes that seek a better understanding on the part of parents and caregivers regarding the importance of integral care for their adolescent children. [ABSTRACT FROM AUTHOR]

The third molar or wisdom teeth are generally the last and posteriorly in position, which is permanent to erupt, usually between the ages of 16 years to 25 years during adolescence and adult age. The usual presentation of wisdom teeth is pain, swelling, tender gums, unpleasant taste, and difficulty in opening the mouth. The objective of this study was to determine the prevalence of impacted third molars, angulations, and levels of eruption in the Qassim region of Saudi Arabia. This investigation was carried out on patients who obtained an orthopantomogram for the complaint of pain or discomfort in the third molar from the Department of Oral Radiology between the years of 2019 to 2022 as part of a retrospective study (OPG), a total of 1,516 OPG taken from patients aged 25 to 46 years. Data was analyzed by using SPSS 21.0 version (IBM Corp., Armonk, NY), and simple proportions and chi-square tests were applied. The pattern of third molar impaction in the present sample is characterized by a relatively high prevalence (33.50 %) and mostly bilateral impaction with male sex predilection. The most common level of impaction was the A level. There was a significant difference between the percentage of males with impacted third molars (72.63 percent) and females with impacted third molars (27.36 percent) (P = 0.001) in the study sample. Five hundred-eight of the OPG appears to show one impacted the third molar. A total of 345 patients had impacted third molars on both sides of their mouths, while 163 patients only had one side of their mouth affected. Level I was significantly more prevalent than Level II, and Level III in both the maxilla and mandible. Based on the results, nearly one-third of the patients have bilateral impaction. The vertical angulation of the mandible and maxilla was by far the most common of all the possible angles. Maxillary both right and left third molars show an almost similar angular pattern of impaction, whereas mandibular right and left third molar shows a significantly different angular pattern of impaction. It will be necessary for future research to analyze the pattern of third molar impaction in other parts of Saudi Arabia. [ABSTRACT FROM AUTHOR]

Introduction: Bruxism is a spectrum of masticatory muscles activities. According to the recent evidence and international consensus, there is no indication to treat bruxism unless clinical consequences are present. The aim of the present study was to investigate the approach of Italian dentists to bruxism in their clinical practice. Methods: An anonymous online survey was developed, composed by 26 items grouped into five sections: (1) Characteristics of the respondent (Q1–Q6); (2) Bruxism frequencies (Q7–Q11); (3) Bruxism assessment (Q12–Q15); (4) Bruxism management (Q16–Q20); (5) Occlusal splints therapy (Q21–Q26). Results: A total of 384 practitioners, including specialists and non‐specialists, participated in this survey. The majority of the respondents reported that 1–3 out of ten patients presented with bruxism. The diagnosis is mainly performed with non‐instrumental methods, and facial pain and dental wear are the major clinical consequence associated with bruxism. Almost the entire sample of respondents report to offer occlusal splints to bruxism patients, and 41% refer to perform occlusal adjustments. Almost half of the respondents have never proposed any form of cognitive‐behavioural therapy. Conclusion: The results of the current survey highlighted several inconsistencies in Italian dentists' approaches to bruxism, suggesting the need for better education of practitioners and for the development of a standardized protocol to assess and manage bruxism in dental practices. [ABSTRACT FROM AUTHOR]

Background: Herpes zoster (HZ) is one of the most common skin diseases caused by viruses. Facial HZ develops when the varicella-zoster virus affects the trigeminal nerve, and alveolar osteonecrosis is a rare complication. However, the exact pathogenesis of postherpetic alveolar osteonecrosis remains unclear. Case description: We encountered a patient who presented to the dermatology clinic with facial HZ and tooth exfoliation in the upper right jaw, and panoramic radiography revealed decreased bone density and poor alveolar socket healing in his right maxilla. Biopsy of the alveolar process revealed fragments of nonvital lamellar bone, which were devoid of osteoblasts and osteocytes and were surrounded by numerous neutrophils and bacterial aggregates. Thus, the diagnosis of alveolar osteonecrosis following facial HZ was confirmed. He then underwent resection of the osteonecrotic tissue. The pathological findings of postoperative tissue were similar to those of previous biopsies. Varicella-zoster virus and multiple types of bacteria were detected through next-generation sequencing, and the species of bacteria were consistent with the results of bacterial culture. Antibiotics and valaciclovir were administered during the perioperative period. The patient showed good recovery at the 9-month follow-up. Conclusions: The coexistence of bacterial and viral infection may play an important role in the pathogenesis of alveolar osteonecrosis following HZ. To our knowledge, we are the first to directly explore microbial pathogens in a case of postherpetic alveolar osteonecrosis through next-generation sequencing and bacterial culture. We recommend that oral examinations be carefully conducted for patients who are diagnosed with facial HZ, even if their facial rashes have faded away. We suggest that a prolonged and full-dose antiviral therapy course may be beneficial for the treatment of facial HZ with intraoral lesions. The implementation of dental preventive measures should be considered for patients with facial HZ. The application of antibiotics and excision of necrotic bone may reduce the abundance of bacteria in lesions and improve wound healing. [ABSTRACT FROM AUTHOR]

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Background/Objective: Coronavirus disease (COVID) 2019-associated mucormycosis is an aggressive fungal infection with an unpredictable outcome and poor prognosis, including a permanent vision loss. It could potentially trigger and amplify mental health problems, and the social support has been known to buffer the negative impact of such a large-scale stressor on mental health. Therefore, the present study aimed to estimate the prevalence and severity of depression, anxiety, and stress with the level of perceived social support and correlation between them in patients with COVID-associated mucormycosis. Materials and Methods: This was a cross-sectional, observational study conducted on 100 patients of mucormycosis at a tertiary care hospital, and the patients were enrolled by a convenience sampling method on the basis of inclusion and exclusion criteria. Depression, anxiety, and Stress Scale-21 items, and Multidimensional Scale of Perceived Social Support with a self-constructed semi-structured pro-forma were used to collect the required data. Results: The prevalence of depression, anxiety, and stress was found to be 49%, 80%, and 56%, respectively. 8.0% perceived low, 65.0% perceived medium, and 27.0% perceived a high social support. No correlation between depression, anxiety, and stress with the perceived social support was found. Conclusions: Our study highlights the burden of psychological issues in mucormycosis patients. Psychiatric implications can be of paramount importance while dealing with pandemics, and therefore, a routine mental health assessment and timely psychological and social interventions can reduce the adverse impact on mental health outcomes. [ABSTRACT FROM AUTHOR]

The article discusses the challenges and improvements in pain education, particularly in the field of chronic pain. It highlights the need for academic integrity, transparency, and evidence-based content in continuing medical education (CME) programs. The Lyceum for Pain Education is presented as an example of a program that addresses these challenges by providing accessible, free, and interdisciplinary education on pain topics. The program has transitioned to a virtual format, reaching a global audience and including patients, public policy makers, and international speakers. The article emphasizes the importance of historical context, reducing industry sponsorship, and reducing the carbon footprint associated with in-person conferences. [Extracted from the article]

Introduction: This study aimed to assess the effect of dental pain on the quality of patients life. Materials and methods: This cross-sectional study evaluated 150 patients presenting to the dental clinic of Kerman Dental School in 2017, complaining of dental pain. A researcher-made questionnaire was used to collect the demographic information of patients and data regarding the type, intensity, and duration of dental pain. After filling out the questionnaire, 30 patients were randomly asked to show up again one month after the treatment, and fill out the same questionnaire for the second time. Data was analyzed by the Chi-square test and t-test (alpha=0.05). Results and discussion: The response rate was 92.3%. The mean duration of pain was 3.6±2.3 months. Of all, 97 patients reported that dental pain changed their lifestyle. The most common changes were reported in sleeping, eating, walking, and driving. The severity of pain had significant correlations with age and gender (P=0.01). The mean acquired score was 69.9±12.2 out of 140. Pain severity was significantly correlated with the questionnaire score (P=0.001). Conclusions: Dental pain can adversely affect sleep quality and eating. Extraction of painful tooth resulted in complete resolution of pain and improved the quality of life in 100% of patients, while root canal treatment, pulpotomy, and pulpectomy resulted in over 70% patient satisfaction. [ABSTRACT FROM AUTHOR]

Asymptomatic primary hyperparathyroidism (PHPT) is often missed in developing nations due to limited formal healthcare exposure and biochemical screening programs. Many patients are thus only diagnosed once symptomatic. We present a 32-year-old female who developed bony protrusions in her jaw during pregnancy, resulting in a stillbirth. Three months later, during a dental consultation for worsening toothache, jaw abnormalities were detected. Radiological studies revealed bilateral mandibular radiolucent lesions, and bone biopsy confirmed histological features consistent with a brown tumor. These findings raised concerns about underlying PHPT, which was confirmed with a markedly elevated parathyroid hormone level in the presence of significant hypercalcemia. Further examination revealed impaired renal function, normal urine calcium excretion, and bilateral nephrocalcinosis. Low bone mineral density was measured with dual-energy X-ray absorptiometry, and conventional radiology identified additional low-density bony lesions in keeping with brown tumors. A parathyroid MIBI confirmed the presence of a singular parathyroid adenoma. A vague but possible family history, the patient's young age, and the severe renal and skeletal involvement prompted genetic testing. A cell division cycle 73 (CDC73) pathogenic variant, in keeping with primary hyperparathyroidism jaw tumor syndrome, was identified. [ABSTRACT FROM AUTHOR]

The modulation of TRPV1 emerges as a promising strategy for dental pain management. This study aimed to assess TRPV1 modulation in a human odontoblast-like cell model using Capsazepine (CZP) loaded in a nanogel delivery system. Gelatin nanogels, synthesized via the emulsification-gelation technique, were characterized and loaded with the TRPV1 antagonist, CZP. HPLC determined a remarkable 67.5 ± 0.04% CZP loading efficiency, with 71.7% of nanogels falling within the 300–950 nm size range, as evidenced by light microscopy. Moreover, CZP-loaded nanogels had a low cytotoxicity. An FTIR analysis showed no adverse chemical interactions, ensuring stability and active release. When examining biological responses, TRPV1 expression and channel activity were assessed in odontoblast-like cells. On the fifth day post-treatment, cells treated with CZP-loaded nanogels exhibited an increased TRPV1 expression and a reduction in calcium fluxes after agonist stimulus (F/F0 ratio 1.18 ± 0.18), resembling the response in free CZP-treated cells (1.28 ± 0.15). A two-way analysis of variance and the Tukey's test were used to determine statistical significance (p < 0.05). This delivery system, proven to be economical and straightforward, holds promise for dental pain management and potential local use. Local administration minimizes systemic adverse effects, making it a practical solution for releasing molecules in the oral cavity. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the association between the oral health status and appetite in community-dwelling older adults. We enrolled 100 people aged >65 years who had participated in long-term care prevention projects between December 2018 and January 2019. Appetite was assessed using the Council on Nutrition Appetite Questionnaire score. The oral health status was assessed based on the number of teeth, occlusal condition, swallowing function, tongue coating, and the Oral Health Assessment Tool. A multiple linear regression analysis was performed with appetite as the dependent variable and each variable related to oral health status as an independent variable. The analysis was adjusted for sex, age, activities of daily living, cognitive function, smoking habit, and alcohol consumption. Dental pain was associated with poor appetite in community-dwelling older adults. No other oral health status parameter was associated with appetite. Thus, controlling dental pain is critical to prevent appetite loss while considering other factors. [ABSTRACT FROM AUTHOR]

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]

Odontogenic pain can be debilitating, and nonopioid analgesic options are limited. This randomized placebo-controlled clinical trial aimed to assess the effectiveness and safety of cannabidiol (CBD) as an analgesic for patients with emergency acute dental pain. Sixty-one patients with moderate to severe toothache were randomized into 3 groups: CBD10 (CBD 10 mg/kg), CBD20 (CBD 20 mg/kg), and placebo. We administered a single dose of respective oral solution and monitored the subjects for 3 h. The primary outcome measure was the numerical pain differences using a visual analog scale (VAS) from baseline within and among the groups. Secondary outcome measures included ordinal pain intensity differences, the onset of significant pain relief, maximum pain relief, changes in bite force within and among the groups, psychoactive effects, mood changes, and other adverse events. Both CBD groups resulted in significant VAS pain reduction compared to their baseline and the placebo group, with a maximum median VAS pain reduction of 73% from baseline pain at the 180-min time point (P < 0.05). CBD20 experienced a faster onset of significant pain relief than CBD10 (15 versus 30 min after drug administration), and both groups reached maximum pain relief at 180-min. Number needed to treat was 3.1 for CBD10 and 2.4 for CBD20. Intragroup comparisons showed a significant increase in bite forces in both CBD groups (P < 0.05) but not in the placebo group (P > 0.05). CBD20 resulted in a significant difference in mean percent bite force change in the 90- and 180-min time points compared to the placebo group (P < 0.05). Compared to placebo, sedation, diarrhea, and abdominal pain were significantly associated with the CBD groups (P < 0.05). There were no other significant psychoactive or mood change effects. This randomized trial provides the first clinical evidence that oral CBD can be an effective and safe analgesic for dental pain. [ABSTRACT FROM AUTHOR]