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Cardiac ischemia, such as angina pectoris or myocardial infarction, is associated with pain in the oral cavity, lower jaw, head, or neck, or spanning from the left upper arm to the shoulder. When presenting to a dentist, however, appropriate treatment for such patients is often delayed, as dental problems are usually the first to be suspected when the chief complaint is orofacial pain. This report describes a case of a 70-year-old woman who was aware of pain and a burning sensation in the oral cavity upon exertion for a year prior to presenting at our clinic. She had been examined by her family physician, an otolaryngologist, and another dentist, none of whom found any abnormalities other than suspected periodontal disease and caries, for which she was treated. An examination at our clinic revealed no abnormal dental findings that would have been consistent with the mandibular pain, however. Although no chest symptoms were reported, pain was elicited on exertion, suggesting cardiogenic toothache. An immediate referral to a cardiologist was therefore made on the same day. The patient visited the cardiology department of the University Hospital of Tokyo Dental College 6 days later. The increased frequency of symptoms on exertion suggested unstable angina, and the patient was admitted to the emergency department on the same day. Emergency coronary angiography showed that right coronary artery #1 was 99% stenosed proximally (highly calcified plaque). The diagnosis was unstable angina pectoris, with the right coronary artery #1 as the responsible lesion, and percutaneous coronary angioplasty was performed on the same day. Subsequently, all the orofacial pain disappeared, confirming unstable angina as the cause. The pain characteristics in this case were consistent with pain associated with cardiac ischemia, which led to the immediate referral to the cardiology department. In cases of toothache associated with cardia ischemia, it is essential to seek cardiological care as soon as possible.

Competing Interests: Potential conflicts of interest . The authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Patients who present with acute or chronic posterior dental pain but cannot identify the tooth from which the pain originates may suffer from a common but often unrecognized condition. The present article introduces a new term for this disorder, ectopic sulcular pain (ESP), derived from its unusual presentation, location, and defining symptom. It is tempting to call ESP an infection, but this has not been confirmed. In ESP, oral examination reveals no visual abnormalities, and there are no evident fractures, caries, periodontitis, attachment loss, traumatic occlusion, or periapical abscesses. This confusing symptomatology often leads to incorrect diagnosis and, consequently, treatment that fails to relieve the patient's pain. This article discusses ESP and reports 13 cases in which the condition was identified via intraligamental or topical application of an anesthetic agent to numb the gingiva. In 12 patients, ESP was successfully treated with meticulous oral hygiene, chlorhexidine rinses, and, in some cases, oral antibiotics., Competing Interests: No conflicts of interest reported.

Patients with recurrent or persistent dentoalveolar pain usually believe that endodontic treatment or extracting a tooth will alleviate it, and most cannot conceive that the pain might not be tooth related. Understanding that dental procedures of any kind will be ineffective when a tooth-related pathology is ruled out and that a nonodontogenic etiology best explains the "toothache" pain goes against their beliefs. In this article, we present an overview of basic concepts to help manage such cases by briefly outlining possible causes of nonodontogenic pain as well as diagnostic pitfalls that may lead to questionable treatments. The decision to provide dental treatment is justified only when definitive peripheral mechanisms driving the pain are uncovered and the multitude of factors that might contribute to the various presentations of persistent dental pain have been considered. Otherwise, patients might be managed with treatments that are not the norm for those with unremitting tooth pain in general dental practice. We also make suggestions for clinicians to assure that patients with recurrent or persistent dental pain receive a thorough work-up that considers odontogenic and nonodontogenic sources to arrive at the correct diagnosis before treatment, taking psychosocial factors into account when devising the treatment plan.

Introduction: This study assessed the accuracy of a TMD Pain Screener questionnaire in identifying patients with temporomandibular disorder (TMD) pain among those seeking endodontic treatment for tooth pain. It also investigated whether the screener accuracy could be improved by adding questions regarding putative predictors of TMD status., Methods: One hundred patients seeking endodontic treatment for tooth pain were enrolled. Participants completed the 6-question TMD Pain Screener before treatment. A board-certified orofacial pain specialist/endodontic resident conducted endodontic and TMD examinations using validated Diagnostic Criteria for TMD (DC/TMD). The sensitivity (Se), specificity (Sp), and positive/negative predictive values (PPVs/NPVs) were calculated for the 6-question and 3-question versions of the TMD Pain Screener. Logistic regression and receiver operating characteristic curve (AUROC) analyses were performed to determine the screening accuracy., Results: At the screening threshold of ≥3, TMD Pain Screener's sensitivity was 0.85, specificity 0.52, PPV 0.68, and NPV 0.75 for the 6-question version and 0.64, 0.65, 0.69, and 0.61, respectively, for the 3-question version. The AUROC was 0.71 (95% CL: 0.61, 0.82) and 0.60 (95% CL: 0.48, 0.71) for full and short versions, respectively. Adding a rating of current pain intensity of the chief complaint to the screener improved the AUROC to 0.81 (95% CL: 0.72, 0.89) and 0.77 (95% CL: 0.67, 0.86) for full and short versions, respectively, signifying useful overall accuracy., Conclusions: The 6-question TMD Pain Screener, combined with the patient's rating of current pain intensity of the chief complaint, could be recommended for use in endodontic patients with tooth pain for detecting painful TMD., (Copyright © 2023 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Barodontalgia, barometric pressure-induced dental pain, may occur during hyperbaric oxygen(HBO 2 ) therapy due to pressure changes. This case report presents an 8-year-old male patient with barodontalgia. The patient declared a severe toothache during HBO 2 therapy. The diving medicine specialist referred the patient to the dental clinician immediately. On clinical examination, the pain was thought to be caused by caries lesions of the deciduous teeth in the left maxillary molar region. Tooth extraction was suggested. After extraction, the patient continued hyperbaric oxygen therapy sessions without any pain. The patient was recommended for an intraoral and radiographic examination session one week after the extraction. In conclusion, caries lesions and faulty restorations should be examined before hyperbaric oxygen therapy sessions. Even though barodontalgia is a rare phenomenon, dental examination is essential to avoid these kinds of pain-related complications. All carious lesions and defective restorations must be treated, if necessary. Removal of faulty restorations and management of inflammation as part of the treatment is suggested before exposure to pressure changes., Competing Interests: The authors of this paper declare no conflicts of interest exist with this submission., (Copyright© Undersea and Hyperbaric Medical Society.)

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

Introduction: The aims of this study were to determine the incidence, associated factors, and predictability of flare-ups after nonsurgical retreatments (NSRetx)., Methods: All patients (n = 3,666) who received NSRetx by 3 endodontists in 2 endodontic offices during a period of 6 years (2016-2022) were included. Demographic, diagnostic, and procedural data were collected. A flare-up was defined as moderate-severe pain with/without swelling that took place within 14 days of initiation of NSRetx and resulted in an unscheduled appointment. Bivariate analyses on the entire cohort and multivariable analyses on cases with complete dataset (n = 2,846) were performed to identify significant associations. A Random Forest algorithm was used to make a prediction model., Results: Incidence of flare-ups was 3.95% (n = 145). Increased risk of flare-ups was associated with diabetes (adjusted odds ratio [AOR] = 2.01; 95% confidence interval [CI], 1.01-3.97), mandibular teeth (AOR = 1.67; 95% CI, 1.11-2.52), moderate-severe preoperative pain on percussion (AOR = 2.13; 95% CI, 1.31-3.50), and pain on palpation (AOR = 1.63; 95% CI, 1.01-2.64). Lower risk of flare-up was associated with high blood pressure (AOR = 0.44; 95% CI, 0.21-0.82) (P < .05). The prediction model was not able to predict flare-ups with sufficient confidence (precision = 0.13)., Conclusions: Incidence of flare-ups following NSRetx was low (∼4%) and had a weak but significant association with the history of diabetes. Moderate-severe pain on percussion, pain on palpation (any intensity), and mandibular teeth had a significant association with flare-ups. The history of high blood pressure was associated with lower risk of flare-ups. Flare-ups were difficult to predict in this clinical setting., (Copyright © 2023 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Herpes zoster (HZ) is an acute and painful neurocutaneous infection caused by the reactivation of a latent varicella-zoster virus in the dorsal root or cranial nerve ganglia. It is characterized by 3 stages: prodromal, acute, and chronic. During the prodromal stage, reactivation in the maxillary branch of the trigeminal nerve closely mimics odontalgia, and HZ should be in the differential diagnosis. Patients with HZ develop painful lesions following the affected dermatome. Laboratory testing confirms the diagnosis; treatment is with antiviral agents. Early detection and treatment shorten the course of the infection and lessen the severity of the associated postherpetic neuralgia., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Introduction: In this study, we aimed to examine dental barotrauma and temporomandibular joint (TMJ) complaints in a large group of divers., Methods: This survey study included scuba divers older than 18. The questionnaire contained 25 questions about the demographic characteristics of divers, dental health behaviors, and diving-related dental, sinus and/or temporomandibular joint pain., Results: The study group consisted of 287 instructors, recreational and commercial divers (mean age 38.96 years) (79.1% males). A total of 46% of divers reported a frequency of tooth brushing less than twice a day; 28% never receive a routine dental examination; 22.6% experienced dental pain after and/or during diving, mostly in the upper posterior teeth (40%); 17% required dental treatment; 77% of these cases are restoration fracture. TMJ symptoms after diving were statistically significantly higher in women (p=0.04). Jaw and masticatory muscle pain in the morning (p≺0.001) limitation of mouth opening (p=0.04) and joint sounds in daily life (p≺0.001) were recorded as exacerbated after diving; the results were found to be statistically significant., Conclusion: In our study, the localization of barodontalgia was consistent with the distribution of caries and restored tooth areas in the literature. Dive-related TMJ pain was also more common in those with pre-dive problems such as bruxism and joint noise. Our results are important to remind us of the necessity of preventive dentistry practices and early diagnosis of problems in divers. Divers should take personal precautions, such as brushing their teeth twice a day and avoiding the need for urgent treatment. The use of a personalized mouthpiece is also recommended for divers to prevent dive-related temporomandibular joint diseases., Competing Interests: The authors of this paper declare no conflicts of interest exist with this submission., (Copyright© Undersea and Hyperbaric Medical Society.)

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., (© 2022. The Author(s), under exclusive licence to The Society of The Nippon Dental University.)

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. Kougeon K, Yasukawa K, Baudet A. Barodontalgia and dental barotrauma among scuba divers . Aerosp Med Hum Perform. 2022; 93(5):421-425.

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 h per day for more than 3 months, in the absence of any preceding causative event'., Methodology: In this observational study, participants fulfilling the new ICOP diagnostic criteria of PIDAP were included, covering 16 years of consecutive data. A systematic, retrospective assessment of patients utilizing 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: Amongst 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 91% 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., (© 2021 The Authors. International Endodontic Journal published by John Wiley & Sons Ltd on behalf of British Endodontic Society.)

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., (© 2021 The Authors. Community Dentistry and Oral Epidemiology published by John Wiley & Sons Ltd.)

Background: When a person feels dental pain, it brings great discomfort and damages the quality of life. Symptomatic apical periodontitis is identified as the most frequent cause that triggers dental pain. Symptomatic apical periodontitis arises from an infection or inflammation in the pulpless root canal structure. According to clinical guidelines, the primary form of therapy for such teeth entails removing the inflammation or infection source through local surgical procedures. Presently, systemic antibiotics are recommended only for cases where there is clear indication of an infectious spread or a systemic involvement. Therefore, this study aims to assess the efficacy and level of safety of using antibiotics to treat adult symptomatic apical periodontitis patients., Methods: The present protocol study will conduct a search on electronic databases to look for randomized controlled trials (RCTs) that have evaluated the effectiveness and safety of antibiotics when used to treat adult patients with symptomatic apical periodontitis. The databases will be search from their beginning to April 2021. The search is not bound by publication status or language restrictions. The following databases will be searched: Web of Science, PubMed, the Cochrane Library, Chinese National Knowledge Infrastructure, and EMBASE. This study will employ ZETOC Conference Proceedings and OpenGrey to identify potential grey literature. Afterwards, 2 independent authors will select the studies, extract data from the studies, and conduct a risk assessment to check for bias. All discrepancies between the authors will be resolute via discussion involving a third independent author. The data synthesis and statistical analysis of this study will be done with the RevMan software (Version: 5.3)., Results: The present protocol report will provide high-quality evidence related to the efficacy and level of safety when using antibiotics to treat mature symptomatic apical periodontitis patients., Conclusion: The outcomes of the present study will update the evidence available for assessing the efficacy and safeness of using antibiotics to treat mature symptomatic apical periodontitis patients., Ethics and Dissemination: This study does not require an ethical approval since individual patient data is not included in any form., Registration Number: DOI 10.17605/OSF.IO/CVP8 M (https://osf.io/cvp8m/)., Competing Interests: The authors have no conflicts of interests to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Multiple roots in anterior teeth are very rarely reported in the literature. The occurrence of multi-rooted canine in primary dentition is an infrequent entity. This unusual abnormality is an accidental finding on routine examination. Radiographic examination plays a significant role in the identification of this anomaly. This rare anomaly has been reported very infrequently reported and has not been published in a Saudi Arabia population. Therefore, the purpose of the present case report is to describe a case of an 8-year old Saudi boy presented with the bimaxillary occurrence of bi-rooted primary canine. This report discusses this unique occurrence in the context of the published literature.

Objective: Low-intensity pulsed ultrasound (LIPUS) is a noninvasive modality to stimulate bone remodeling (BR) and the healing of hard and soft tissues. This research evaluates the biostimulatory effect of LIPUS on the rate of orthodontic tooth movement (OTM) and associated pain, when applied at 3-week intervals., Methods: Twenty-two patients (11 males and 11 females; mean age 19.18 ± 2.00 years) having Angle's Class II division 1 malocclusion needing bilateral extractions of maxillary first bicuspids were recruited for this split-mouth randomized clinical trial. After the initial stage of alignment and leveling with contemporary edgewise MBT (McLaughlin-Bennett-Trevisi) prescription brackets (Ortho Organizers, Carlsbad, Calif) of 22 mil, followed by extractions of premolars bilaterally, 6 mm nickel-titanium spring was used to retract the canines separately by applying 150 g force on 0.019 × 0.025-in stainless steel working archwires. LIPUS (1.1 MHz frequency and 30 mW/cm 2 intensity output) was applied for 20 minutes extraorally and reapplied after 3 weeks for 2 more successive visits over the root of maxillary canine on the experimental side whereas the other side was placebo. A numerical rating scale- (NRS-) based questionnaire was given to the patients on each visit to record their weekly pain experience. Impressions were also made at each visit before the application of LIPUS (T1, T2, and T3). Models were scanned with a CAD/CAM scanner (Planmeca, Helsinki, Finland). Mann-Whitney U test was applied for comparison of canine movement and pain intensity between both the groups., Results: No significant difference in the rate of canine movement was found among the experimental (0.90 mm ± 0.33 mm) and placebo groups (0.81 mm ± 0.32 mm). There was no difference in pain reduction between experimental and placebo groups ( p > 0.05)., Conclusion: Single-dose application of LIPUS at 3-week intervals is ineffective in stimulating the OTM and reducing associated treatment pain., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Irfan Qamruddin et al.)

Chronic overlapping pain conditions (COPCs) are conditions that share several clinical characteristics and symptomatology, are usually considered idiopathic in nature, and are frequently comorbid. Currently, there are no established inclusion criteria to determine which conditions should be included under this umbrella term despite different systems proposed. Persistent dentoalveolar pain disorder (PDAP), also referred to as atypical odontalgia and thought to be a component of persistent idiopathic facial pain, is a chronic pain condition that manifests as a persistent tooth pain or pain over a dentoalveolar site formerly occupied by a tooth in the absence of detectable pathology during clinical or radiological examination. PDAP is considered idiopathic in nature, and its pathophysiological mechanisms are not fully understood. Our objective was to investigate whether PDAP fits the conceptual paradigm of COPC given its characteristics and commonalities with other COPC, based on published literature identified through a scoping review. We found that PDAP fits 16 out of 18 common characteristics among COPCs, and based on this finding, we discuss the implications of PDAP being considered a COPC., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. All rights reserved.)

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.

The aim of this study was to evaluate the factors associated with toothache in the adult population of Minas Gerais, Brazil. Individual data from a population sample (age 35 to 44 years) were collected from a secondary database of the SB Minas survey. Sampling was carried out by clusters and with multiple drawing stages. The eligibility criteria were to reside in areas chosen for the research, be within the age group, and accept to participate in the research. The individual variables assessed by a questionnaire and dental exams were sex, income, race/skin color, root caries, periodontal condition, need for dental treatment, and last dental appointment. The contextual variables, assessed by municipal indexes, were Human Development Index (HDI), illiteracy, unemployment, half minimum wage, quarter minimum wage, oral health team coverage, access to individual health care, and supervised tooth brushing average. The dependent variable was toothache in the past six months. A descriptive analysis was made using the Statistical Package for the Social Sciences and Hierarchical Linear and Nonlinear Modeling Software was used to perform the multilevel analyses for individual and contextual levels. An association was found between toothache and low income (OR = 2.00; 95%CI = 1.32-3.13), dental caries (OR = 1.86; 95%CI = 1.22-2.86), periodontal condition, and living on a quarter of the minimum wage or less (OR = 1.03; 95%CI = 1.00-1.08). Clinical and social factors were associated with toothache, reinforcing the need to improve public polices in oral health focused on the adult population.

Amyloidosis and lymphoma localized to the ocular adnexa are rare, and their presentation may resemble more common inflammatory conditions such as autoimmune disease or infection, which can protract diagnostic evaluation and delay eventual therapy. In a patient with recalcitrant facial and tooth pain and ophthalmoplegia, evaluation should include careful histopathologic analysis of biopsy specimens. We report a case of orbital AL amyloidosis associated with localized lymphoma that presented with intractable dental pain and progressed to bilateral complete ophthalmoplegia.

Introduction: Orthodontic pain is the most common adverse side effect reported in the context of tooth movement. Given its central role in processing pain and negative emotion, the central nucleus of the amygdala (CeA) is thought to be a key site involved in orthodontic pain sensation., Methods: In the present study, we therefore explored whether the CeA is involved in contributing to orthodontic pain in a rat model of tooth movement. For this study, we utilized adult male rats with bilateral sham or electrolytic CeA lesions (400 μA; 25 s), and then we analyzed face grooming behavior as a measure of pain sensation., Results: Through this approach, we found that there were time- and force-dependent factors influencing pain levels in these rats. We further found that bilateral CeA lesions markedly reduced tooth movement-induced orofacial pain and that unilateral CeA lesions did so to a lesser extent., Conclusions: As such, these results suggest the CeA is a key area of orthodontic pain, with the results of this study highlighting potential avenues for achieving pain relief in those suffering from orthodontic pain., (© 2019 The Authors. Brain and Behavior published by Wiley Periodicals, Inc.)

Objective: To investigate the prevalence of dental pain among adolescent students and its association with individual, school and city variables, using a multilevel approach., Subjects and Methods: Individual and school data were obtained from the National Adolescent School-Based Health Survey (PeNSE) conducted in Brazil in 2015 in a sample of 34,776 students from 1,339 schools in the 27 Brazilian capital cities. Secondary data on socioeconomic, structural and health indicators of the cities were obtained from public databases. The outcome was the prevalence of dental pain in the last six months (yes/no). Independent variables, consisting of potential social and behavioural determinants of dental pain, were structured in three levels: individual, school and city. Multilevel logistic regression was performed., Results: Prevalence of dental pain was 21.8% (95% CI = 21.0-22.7). Unadjusted analysis showed significant associations between the outcome and most of the factors in the individual and in the contextual levels. In the final adjusted model, adolescents who reported unfavourable health-related behaviours, adverse socioeconomic or psychosocial characteristics, as well as those attending public schools and living in cities with high caries prevalence (DMFT) at age 12, were more likely to report dental pain., Conclusions: Prevalence of dental pain was high and associated with adverse individual and contextual factors in the school and city levels., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. All rights reserved.)

The symptoms of sudden severe headache and/or diminished consciousness characterize the onset of aneurysmal subarachnoid hemorrhage (SAH). However, several studies have suggested that some patients show an atypical presentation at the onset: symptoms lacking sudden headache and diminished consciousness. These atypical symptoms can easily lead to misdiagnosis. This paper reported the death cases of acute aneurysmal subarachnoid hemorrhage with toothache as the first symptom, hoping to provide clinical evidence for the general public doctors to reduce the misdiagnosis and delayed diagnosis of SAH, improve the identification ability of SAH, and prevent such death events from happening again.

Tooth pain is a common presentation in primary care, with 32.4% of Singaporeans experiencing pain from dental caries in their lifetime. Some systemic conditions can have oral presentations, and oral conditions may be associated with chronic disease. A good history and examination is key in delineating odontogenic from non-odontogenic causes of tooth pain. Primary care physicians should accurately diagnose and assess common dental conditions and make appropriate referrals to the dentist. Common non-odontogenic causes of orofacial pain can be mostly managed in primary care, but important diagnoses such as acute coronary syndrome, peritonsillar abscess and temporal arteritis must not be missed. Ibuprofen has been shown to be effacious, safe and cost-effective in managing odontogenic pain. Antibiotics are indicated when there is systemic or local spread of dental infection. Without evidence of spread, antibiotics have not been shown to reduce pain or prevent subsequent dental infections., (Copyright: © Singapore Medical Association.)

BACKGROUND: Barodontalgia, barometric pressure-induced dental pain, may jeopardize diving/flight safety. The aim of this systematic review was to investigate the rate of barodontalgia among military and civilian divers and aircrews based on previous reports. METHODS: We analyzed the data of 4894 aircrew/divers reported in the literature. Barodontalgia rates (flight vs. diving, military vs. civilian, pressurized vs. non-pressurized aircrafts) were analyzed. The Chi-squared test was used to compare between groups. RESULTS: Of the 4894 individuals, 402 (8.2%) suffered from barodontalgia. Divers (9.8%) were more vulnerable than aircrews (5.8%). Barodontalgia experience rate was 5.4% and 6.5% in military and civilian aircrews, respectively, and 7.3% and 12.8% in military and civilian scuba divers, respectively. Barodontalgia was more common among aircrews of pressurized than non-pressurized aircrafts (7.3% vs. 3.2%, respectively). DISCUSSION: The greater amplitude of barometric pressure changes explains the higher rate of barodontalgia in divers than aircrew. The higher rate during pressurized flights is possibly because intracabin pressure in the pressurized cabin is still routinely higher than in nonpressurized aircrafts. Improved oral care and mandatory annual dental checkups may be the reason for the significantly lower rate of barodontalgia experienced among military aircrews and divers compared to their civilian counterparts. These results emphasize the essential role of atmospheric pressure change in the generation of pain during flight or diving and the importance of proper dental care. Nakdimon I, Zadik Y. Barodontalgia among aircrew and divers . Aerosp Med Hum Perform. 2019; 90(2):128-131.

Dental pain is a common health problem that negatively impacts the activities of daily living. Dentine hypersensitivity and pulpitis-associated pain are among the most common types of dental pain. Patients with these conditions feel pain upon exposure of the affected tooth to various external stimuli. However, the molecular mechanisms underlying dental pain, especially the transduction of external stimuli to electrical signals in the nerve, remain unclear. Numerous ion channels and receptors localized in the dental primary afferent neurons (DPAs) and odontoblasts have been implicated in the transduction of dental pain, and functional expression of various polymodal transient receptor potential (TRP) channels has been detected in DPAs and odontoblasts. External stimuli-induced dentinal tubular fluid movement can activate TRP channels on DPAs and odontoblasts. The odontoblasts can in turn activate the DPAs by paracrine signaling through ATP and glutamate release. In pulpitis, inflammatory mediators may sensitize the DPAs. They could also induce post-translational modifications of TRP channels, increase trafficking of these channels to nerve terminals, and increase the sensitivity of these channels to stimuli. Additionally, in caries-induced pulpitis, bacterial products can directly activate TRP channels on DPAs. In this review, we provide an overview of the TRP channels expressed in the various tooth structures, and we discuss their involvement in the development of dental pain.

Objective: The aim of this study was to evaluate patients' pain levels during four different debonding procedures. The null hypothesis was that the pain perception of the patients undergoing four different debonding applications was not statistically significant different., Material and Methods: One hundred and twenty orthodontic patients who underwent orthodontic debonding were included in this study. The patients were randomly divided into 4 groups according to technique used in the patients. Debonding groups were as follows: Group 1) Conventional debonding group, Group 2) Medication group (acetaminophen was given 1 hour before debonding), Group 3) Soft bite wax group, and Group 4) Soft acrylic bite wafer group. The patients' levels of anxiety and fear of pain were evaluated before debonding, and Numerical Rating Scale (NRS) was applied to evaluate their pain perception during debonding. Mann-Whitney U and Kruskal-Wallis tests were used to evaluate non-normally distributed data. Categorical data analysis were carried by chi-square and McNemar tests. The significance level was set at p<0.05., Results: Anxiety scores of the patients were not statistically significant between both genders and debonding groups. In the quadrants in which the patients were perceived, the highest pain level was in the left side of the mandible. The teeth in which the highest pain level was perceived were the lower left and upper right lateral incisors. Although there was no statistically significant difference among the pain scores of the patients in each group, quadrant scores of female patients showed significant differences, being the lowest scores in the soft bite wax group., Conclusions: Majority of the patients had no fear of pain before debonding. Pain levels of the patients in the conventional debonding group were not significantly different from those of the other groups, except quadrant scores of females in the soft bite wax group. The null hypothesis was accepted.

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.

Objective: This article describes an atypical herpes zoster (HZ) infection heralded by prodromic dental pain., Background: Trigeminal HZ is associated with any of the three divisions of the trigeminal nerve, and Ramsay Hunt syndrome is a rare variant of HZ infection of the ear, often accompanied with unilateral facial nerve palsy., Materials and Methods: An 87-year-old man sought remedy for tooth-like pain. Within a week, he developed cutaneous, intraoral and otic eruptions, hearing loss, and mild facial palsy., Results: After ruling out odontogenic pain, he was diagnosed with trigeminal HZ and Ramsay Hunt syndrome., Conclusion: Herpes zoster infection should be included as a possible aetiologic factor with atypical presentations of odontogenic pain. Diagnosis of trigeminal HZ infection and the Ramsay Hunt syndrome may lead to timely intervention with antivirals and improved patient outcomes., (© 2018 Gerodontology Association and John Wiley & Sons Ltd.)

Aim: This was primarily to perform a retrospective analysis of 1000 emergency dental visits in order to characterize the nature of the dental emergency and the treatment provided and secondly to define a guideline for dental emergency treatment in children including pain management., Materials and Methods: A retrospective review was conducted of 1000 patients (aged 0-16 years) who visited the dental emergency service of the paediatric dental clinic at the Ghent University Hospital, Belgium over a period of 3 years. Data regarding age, gender, reason for visit, year of visit, consequent appointments and treatment provided were collected. Statistical analysis was carried out using descriptive statistics (frequency distribution) and Chi-square test, with significance level set as P < 0.05., Results: The number of patients visiting with a dental emergency increased annually. Approximately half (50.2%) of all paediatric dental emergency consultations were based on pain due to caries and its consequences. More than a quartile (26.7%) of emergency patients suffered from dental trauma of either primar or permanent teeth. The majority (96.7%) of the patients reported pain, 16.3% of the patients did not necessarily need immediate attention., Conclusion: Dental emergencies in a university hospital based setting were predominantly related to caries and trauma. A precise definition of dental emergencies is recommended in order to prevent abuse of paediatric emergency services.

A 37-year-old gravida 5 para 4 with gestational hypertension underwent uneventful repeat cesarean delivery and tubal ligation under combined spinal-epidural anesthesia. On postoperative day 3, she developed a postural headache, unrelieved by caffeine, ibuprofen, and hydration. On postoperative day 8, she returned to the hospital for treatment. An epidural blood patch was administered, providing immediate and complete relief of her headache and bilateral upper and lower dental pain, which she noted arising concomitantly with her headache. We suspect bilateral traction on cranial nerve V2 and V3, secondary to intracranial hypotension after dural puncture, as the cause of her pain.

Background: Initial arch wires are the first arch wires to be inserted into the fixed appliance at the beginning of orthodontic treatment and are used mainly for the alignment of teeth by correcting crowding and rotations. With a number of different types of orthodontic arch wires available for initial tooth alignment, it is important to understand which wire is most efficient, as well as which wires cause least amount of root resorption and pain during the initial aligning stage of treatment. This is an update of the review entitledInitial arch wires for alignment of crooked teeth with fixed orthodontic braces, which was first published in 2010., Objectives: To assess the effects of initial arch wires for the alignment of teeth with fixed orthodontic braces, in terms of the rate of tooth alignment, amount of root resorption accompanying tooth movement, and intensity of pain experienced by patients during the initial alignment stage of treatment., Search Methods: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 5 October 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 9), MEDLINE Ovid (1946 to 5 October 2017), and Embase Ovid (1980 to 5 October 2017. The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases., Selection Criteria: We included randomised controlled trials (RCTs) of initial arch wires to align teeth with fixed orthodontic braces. We included only studies involving participants with upper or lower, or both, full arch fixed orthodontic appliances., Data Collection and Analysis: Two review authors were responsible for study selection, 'Risk of bias' assessment and data extraction. We resolved disagreements by discussion between the review authors. We contacted corresponding authors of included studies to obtain missing information. We assessed the quality of the evidence for each comparison and outcome as high, moderate, low or very low, according to GRADE criteria., Main Results: For this update, we found three new RCTs (228 participants), bringing the total to 12 RCTs with 799 participants. We judged three studies to be at high risk of bias, and three to be at low risk of bias; six were unclear. None of the studies reported the adverse outcome of root resorption. The review assessed six comparisons.1. Multistrand stainless steel versus superelastic nickel-titanium (NiTi) arch wires. There were five studies in this group and it was appropriate to undertake a meta-analysis of two of them. There is insufficient evidence from these studies to determine whether there is a difference in rate of alignment between multistrand stainless steel and superelastic NiTi arch wires (mean difference (MD) -7.5 mm per month, 95% confidence interval (CI) -26.27 to 11.27; 1 study, 48 participants; low-quality evidence). The findings for pain at day 1 as measured on a 100 mm visual analogue scale suggested that there was no meaningful difference between the interventions (MD -2.68 mm, 95% CI -6.75 to 1.38; 2 studies, 127 participants; moderate-quality evidence).2. Multistrand stainless steel versus thermoelastic NiTi arch wires. There were two studies in this group, but it was not appropriate to undertake a meta-analysis of the data. There is insufficient evidence from the studies to determine whether there is a difference in rate of alignment between multistrand stainless steel and thermoelastic NiTi arch wires (low-quality evidence). Pain was not measured.3. Conventional NiTi versus superelastic NiTi arch wires. There were three studies in this group, but it was not appropriate to undertake a meta-analysis of the data. There is insufficient evidence from these studies to determine whether there is any difference between conventional and superelastic NiTi arch wires with regard to either alignment or pain (low- to very low-quality evidence).4. Conventional NiTi versus thermoelastic NiTi arch wires. There were two studies in this group, but it was not appropriate to undertake a meta-analysis of the data. There is insufficient evidence from these studies to determine whether there is a difference in alignment between conventional and thermoelastic NiTi arch wires (low-quality evidence). Pain was not measured.5. Single-strand superelastic NiTi versus coaxial superelastic NiTi arch wires. There was only one study (24 participants) in this group. There is moderate-quality evidence that coaxial superelastic NiTi can produce greater tooth movement over 12 weeks (MD -6.76 mm, 95% CI -7.98 to -5.55). Pain was not measured.6. Superelastic NiTi versus thermoelastic NiTi arch wires. There were three studies in this group, but it was not appropriate to undertake a meta-analysis of the data. There is insufficient evidence from these studies to determine whether there is a difference in alignment or pain between superelastic and thermoelastic NiTi arch wires (low-quality evidence)., Authors' Conclusions: Moderate-quality evidence shows that arch wires of coaxial superelastic nickel-titanium (NiTi) can produce greater tooth movement over 12 weeks than arch wires made of single-strand superelastic NiTi. Moderate-quality evidence also suggests there may be no difference in pain at day 1 between multistrand stainless steel arch wires and superelastic NiTi arch wires. Other than these findings, there is insufficient evidence to determine whether any particular arch wire material is superior to any other in terms of alignment rate, time to alignment, pain and root resorption.

Low-level laser therapy (LLLT) may have an effect on the pain associated with orthodontic treatment. The aim of this study was to evaluate the effect of LLLT on pain and somatosensory sensitization induced by orthodontic treatment. Forty individuals (12-33 years old; mean ± standard deviations: 20.8 ± 5.9 years) scheduled to receive orthodontic treatment were randomly divided into a laser group (LG) or a placebo group (PG) (1:1). The LG received LLLT (810-nm gallium-aluminium-arsenic diode laser in continuous mode with the power set at 400 mW, 2 J·cm -2 ) at 0 h, 2 h, 24 h, 4 d, and 7 d after treatment, and the PG received inactive treatment at the same time points. In both groups, the non-treated side served as a control. A numerical rating scale (NRS) of pain, pressure pain thresholds (PPTs), cold detection thresholds (CDTs), warmth detection thresholds (WDTs), cold pain thresholds (CPTs), and heat pain thresholds (HPTs) were tested on both sides at the gingiva and canine tooth and on the hand. The data were analysed by a repeated measures analysis of variance (ANOVA). The NRS pain scores were significantly lower in the LG group (P = 0.01). The CDTs, CPTs, WDTs, HPTs, and PPTs at the gingiva and the PPTs at the canine tooth were significantly less sensitive on the treatment side of the LG compared with that of the PG (P < 0.033). The parameters tested also showed significantly less sensitivity on the non-treatment side of the LG compared to that of the PG (P < 0.043). There were no differences between the groups for any quantitative sensory testing (QST) measures of the hand. The application of LLLT appears to reduce the pain and sensitivity of the tooth and gingiva associated with orthodontic treatment and may have contralateral effects within the trigeminal system but no generalized QST effects. Thus, the present study indicated a significant analgesia effect of LLLT application during orthodontic treatment. Further clinical applications are suggested.

Background: Dental pain is one of the most common symptoms of untreated oral problems and exerts a strong impact on the well-being of children., Aims: The aim of this study was to evaluate the associated factors with dental pain in children aged 1-3 years using the Brazilian version of the Dental Discomfort Questionnaire (DDQ-B)., Methods: A cross-sectional study was conducted in the city of Diamantina, Brazil. A total of 318 randomly selected children were submitted to an oral clinical examination for the evaluation of tooth injuries and dental caries (International Caries Detection and Assessment System, [ICDAS]). The caregivers of the children were asked to answer the DDQ-B as well as a questionnaire addressing demographic and socioeconomic aspects of the family. Statistical analysis was performed and involved the description of frequencies as well as Poisson hierarchical regression analysis., Results: Dental pain was associated with a household income less than the Brazilian minimum monthly wage (Prevalence ratios [PRs] = 1.33, 95% confidence interval [CI]: 1.07-1.66, P = 0.011) and dental caries in dentin - ICDAS codes 5 and 6 (PR = 1.48, 95% CI: 1.13-1.94, P = 0.004)., Conclusions: Greater frequencies of dental pain were found in 1-3-year-old children from families with a low monthly income and dental caries with visible dentin with or without pulp involvement., Competing Interests: There are no conflicts of interest

Introduction: Endodontic pain is a symptom of pulpal and/or periapical inflammation. One strategy for pain reduction is using medications, such as dexamethasone. A definitive protocol for preventing and controlling pain caused by irreversible pulpitis during endodontic treatment has not yet been established. This is a systematic review to answer the following question: is the use of dexamethasone effective in controlling pain associated with symptomatic irreversible pulpitis?, Methods: This study was registered in the PROSPERO database (CRD42017058704), and Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement recommendations were followed. MEDLINE, Scopus, ScienceDirect, Web of Science, Latin American Caribbean Health Sciences Literature, Cochrane Library, and Google Scholar databases were used in our research. No restrictions were applied to dates or language of publication. All records identified electronically were organized and evaluated by 2 independent authors, and, in case of doubt, a third author made the decision. The Cochrane Collaboration tool was used. The data were analyzed with RevMan 5 software (The Cochrane Collaboration, Copenhagen, Denmark), and data from eligible studies were dichotomous (with and without pain)., Results: A total of 4825 studies were identified. After screening, 523 studies were selected, and, after careful evaluation, only 5 articles remained. All meta-analyses revealed a global effect (P < .05, P < .05, and P < .05), which means that 4 mg dexamethasone helps relieve pain, sometimes for up to 8, 12, and 24 hours., Conclusions: The pain felt by patients diagnosed with symptomatic irreversible pulpitis may be alleviated by administering 4 mg dexamethasone either by mouth or through intraligamentary and mainly supraperiosteal injections into the root canal for up to 24 hours., (Copyright © 2018 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objectives: To quantify the intensity and duration of pain experience in adults over the initial three visits of fixed appliance-based orthodontic treatment. A secondary objective was to assess the relationship between pain experience and analgesic use, dental irregularity, gender, and age., Materials and Methods: A prospective longitudinal study design was adopted. Fifty-eight adults undergoing fixed appliance treatment in five orthodontic practices recorded pain experience at four time points (4 hours, 24 hours, 3 days, and 7 days) following the initial bond-up appointment (T0) and first (T1) and second (T2) routine follow-up adjustment appointments using a visual analogue scale. In addition, subjects recorded the dosage and frequency of analgesic use., Results: A slightly greater proportion of women (57%) were recruited, with a mean sample age of 34.69 (SD 12.11) years. Peak pain was experienced between 24 hours and 3 days following appliance placement (T0) and subsequent adjustments (T1 and T2). The highest mean pain score arose at T0 followed by T2 and T1 adjustments, with the difference between pain levels at these appointment intervals being statistically significant ( P < .001). The use of analgesics following each appointment mirrored pain experience, with pain score, appointment, and time point all being significant predictors of analgesic consumption. The level of dental irregularity, gender, or age did not predict pain levels reported., Conclusions: Adults undergoing fixed orthodontic therapy should be advised that they are most likely to experience increased levels of pain for 1 to 3 days following placement of their appliance and subsequent adjustment visits.

Background: This paper aimed to compare the tooth color changes and sensitivity in patients undergoing dental bleaching with 10% hydrogen peroxide using customized trays or strips as delivering systems., Methods: A total of 50 patients aged between 18-30 years old were assigned into two groups (N.=25) according to the bleaching treatment: tray (TB) or strips (SB). For both techniques, the patients underwent a 30-minute application of 10% hydrogen peroxide twice a day for seven days. Tooth color was evaluated before, 3 and 7 days of treatment, and 14 days after bleaching using a tooth color shade guide (VITA® shade). Tooth sensitivity was assessed using the Visual Analogue Scale (VAS). The values obtained from the color changes and tooth sensitivity were statistically analyzed (α=5%)., Results: For both groups, there was a significant difference on the tooth color before and after bleaching (P<0.001), although there was no significant difference between them (P=0.4215). The SB group exhibited a lower frequency of sensitivity (50.2%) compared to the TB group (70.2%) (P<0.001). However, the highest number of individuals reporting score 1 of sensitivity was found in the SB group (37.3%) compared to the TB group (20.9%) (P<0.001). For the other scores, there were no differences between the SB and TB groups, with results of 9.8% and 8.4% for score 2 (P=0.744) and 2.7% and 0.5% for score 3 (P=0.122)., Conclusions: The bleaching effect of 10% hydrogen peroxide is not influenced by the delivering system (tray or strips). Even though the technique with strips was associated to a lower frequency of dental sensitivity, the peak level of pain was greater when compared to the technique using trays.

The purpose of this systematic review and meta-analysis was to evaluate utilisation of supplementary techniques for pain control during root canal treatment of lower molars with irreversible pulpitis. The literature was searched using electronic databases up to year 2012. Seventeen studies with 1504 participants were included and each study compared experimental interventions with a standard treatment, i.e. the inferior alveolar nerve block. Changing the injection techniques or supplemental injection had no significant effect on pulp anaesthesia compared to the standard treatment (P = 1.00 or P = 0.14), whereas changing anaesthetic features and increasing anaesthetic volumes resulted in significantly higher rates of anaesthesia than those of the standard treatment (P = 0.03 and P = 0.007, respectively). Premedication with non-steroidal anti-inflammatory drugs (NSAIDs) also significantly increased the success rate of anaesthesia (P = 0.001). Taken together, increased anaesthetic volumes and premedication with NSAIDs provide predictable anaesthesia and more pain control during endodontic treatment of lower molars with irreversible pulpitis., (© 2017 Australian Society of Endodontology Inc.)

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

The aim of the present study was to evaluate the influence of the severity/activity of dental caries as well as sense of coherence (SOC) and locus of control (LOC) on oral health-related quality of life (OHRQoL) among 5-year-old children. A cross-sectional study was conducted involving 769 children at schools in a city in northeast Brazil. Parents/caregivers answered validated questionnaires addressing SOC and LOC. The children and parents/caregivers answered their respective modules of the Brazilian version of the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5). Data were also collected on sociodemographic characteristics, visits to the dentist, and the occurrence of toothache. Clinical examinations were performed by 2 trained examiners. A directed acyclic graph was used to select covariates for statistical adjustment, and logistic regression for complex samples was used to test associations between the dependent and independent variables (α = 5%). For parents/caregivers, the variables associated with a negative impact on OHRQoL were the occurrence of toothache (odds ratio, OR: 10.53; 95% confidence interval, CI: 6.34-17.51; p < 0.001) and a low SOC (OR: 2.17; 95% CI: 1.37-3.43; p = 0.001). According to the children's perceptions, the following variables were associated with a negative impact on OHRQoL: toothache (OR: 3.58; 95% CI: 2.30-5.55; p < 0.001), caries activity (OR: 1.97; 95% CI: 1.07-3.62; p = 0.028), and traumatic dental injury (OR: 1.71; 95% CI: 1.15-2.53; p = 0.007). Among parents/caregivers, a low SOC led to poorer OHRQoL. For the children, however, neither psychological aspect affected OHRQoL. In the perception of both the parents/caregivers and children, toothache was the oral condition that exerted a negative impact on OHRQoL., (© 2018 S. Karger AG, Basel.)