Causal relationship between PCOS and related sex hormones with oral inflammatory diseases: a bidirectional Mendelian randomization study

Background

Observational studies have identified a strong association between polycystic ovary syndrome (PCOS) and hormone levels related to oral inflammatory diseases. To better understand the relationship between them, we conducted an analysis using a two-sample Mendelian randomization (MR) approach.

Methods

We gathered summary statistical data from previously published genome-wide association studies (GWAS) on PCOS and three sex hormones (AMH, Estradiol, LH) along with four oral inflammatory diseases (painful gums, loose teeth, mouth ulcers, and toothache). We selected single nucleotide polymorphisms (SNPs) as instrumental variables and employed four types of MR analysis methods to evaluate causal relationships between exposure and outcome. Finally, the robustness of our results was further validated through sensitivity tests and reverse MR.

Results

We observed that PCOS could increase the risk of mouth ulcers (ORIVW= 1.0013, 95%CI: 1.0001-1.0025, PIVW = 0.0278), painful gums (ORIVW= 1.0015, 95%CI:1.0003-1.0027, PIVW = 0.0163), and loose teeth (ORIVW= 1.0014, 95%CI: 1.0001-1.0027, PIVW = 0.0328). Moreover, LH was also found to increase the risk of mouth ulcers (ORIVW= 1.0031, 95%CI: 0.0001-1.0062, PIVW = 0.0457). MR-Egger regression, weighted mode, and WE indicated similar results. Additionally, we discovered no causal link between PCOS and toothache (PIVW>0.05), LH and painful gums, loose teeth, or toothache (PIVW>0.05), or AMH and Estradiol level with any of the four oral diseases (PIVW>0.05).

Conclusion

Our research provides new insights and references for exploring the effects of PCOS and related hormones on oral inflammatory lesions. For patients with PCOS, especially those with elevated LH levels, early intervention measures should be taken to prevent the occurrence of oral inflammatory diseases.

Visually impaired population from low socioeconomic strata and their oral health status: an observational study

A significant portion of the world's population suffers from blindness. Despite being a vital part of systemic health, oral health is neglected in such a population. The present study aimed to determine the oral health status of blind individuals in north India and to identify the factors affecting it. Sixty-nine blind students from a local school for the visually impaired were included in the study. A questionnaire was used to record the basic demographic details and oral habits, followed by an oral examination by a single trained dentist to record dental caries, periodontal status and dental trauma. The prevalence of Dental caries was 63.8% (mean 1.43 ± 1.61). Gingival bleeding on probing (BOP) was found in 60.9% of individuals. Dental trauma prevalence was 23.2%, and harmful oral habits were found in 31.9% of individuals. Individuals experiencing a toothache in the last year had a 1.784 times higher risk of dental caries than those who didn't experience a toothache. Individuals having acquired blindness are 2.411 times more prone to dental trauma in comparison to those suffering from congenital blindness. Blind individuals have poor oral health. Toothache in the last one year is an important risk factor for dental caries in such individuals. Acquired blindness makes a person more susceptible to dental trauma than congenital blindness.

Effects of universal oral healthcare coverage in an adult population: A long-term nationwide natural experiment

OBJECTIVES

A large and long-term natural experiment occurred in Finland from the late 1980s-2000, when adults' entitlement to subsidized oral healthcare was strongly dependent on the arbitrary classification based on their year of birth: people born in 1956 or later were entitled to subsidized care, while people born before 1956 were not. The aim of this study was to investigate the effect of this expanded universal oral healthcare coverage on service use and oral health outcomes.

METHODS

Data from annual nationally representative cross-sectional postal surveys among 15-64-year-olds between 1990 and 2014 were used. For this study, the following outcome variables were formed: experiencing toothache during the past month (yes/no), the number of missing teeth with three different thresholds (over 10, over 5 or at least 1 missing tooth), brushing more than once a day and the number of visits to the dentist. Regression discontinuity plots and bias-corrected local polynomial regression discontinuity estimators measuring the effect of the extended universal coverage on the outcomes at the year-of-birth cut-off of 1956 were generated separately from the data from 1990 to 2000 and from 2002 to 2014.

RESULTS

Between 1990 and 2000, the number of visits to the dentist (0.2 visits, 95% CI, confidence intervals: -0.03; 0.43) and the proportion of those who visited the dentist during the past 12 months (4.2%, 95% CI: 0.1%; 8.3%) increased at the year-of-birth cut-off of 1956. There were minor drops (1.5%-1.9%) in the number of missing teeth across all thresholds (over 10, over 5, or at least 1 missing teeth) at the cut-off. Analyses with the data from the surveys from 2002 to 2014 showed that there were no discontinuities in these outcomes at the cut-off of 1956. Regression discontinuity estimates related to toothache experience and toothbrushing frequency were inconclusive due to high variability in the underlying data and the likely small effect of the more universal coverage on these outcomes.

CONCLUSIONS

The current study provided evidence of the beneficial effects of universal oral healthcare coverage on the oral healthcare service use and teeth preservation from a large and long-term natural experiment occurred in Finland from the late 1980s to 2000.

Outreach dental care program for older adults using residential care or day care services in Hong Kong: A cohort study

AIM

To evaluate the effects of an outreach dental care program (ODCP) on the oral health status and oral health-related quality of life (OHRQoL) of older adults who used residential or day care services in Hong Kong.

METHODS

Older adults who had received dental treatments provided in the ODCP were recruited. Clinical examinations were performed by one calibrated examiner (SXY) at baseline and 1-year follow-up in the residential homes or day care centres. Face-to-face interviews were conducted using the transition scale of the Oral Health Impacts on Daily Living (OHIDL) questionnaire to investigate the perceived change in OHRQoL at baseline, 2-month and 1-year follow-ups. The Wilcoxon matched-pair signed-rank test or McNemar/McNemar-Bowker test was used to explore the change in oral health status after dental treatments. Factors associated with the perceived change in OHRQoL were explored with binary logistic regression.

RESULTS

Four hundred and thirteen older adults (mean age = 83.8 years) participated in the study at baseline, and 377 (91.3%) and 359 (86.9%) were successfully followed 2 months and 1 year after receiving the outreach dental service, respectively. At the 1-year follow-up, the number of decayed teeth and functional tooth units, and the prevalence of poor denture hygiene decreased while there was more dental plaque deposition and a higher proportion of participants with gingival bleeding upon probing. More than 50% of the participants perceived no change or an improvement in OHRQoL in all domains at both follow-ups. Older adults who perceived their oral health status as 'healthy or fair' and those who suffered from toothache at baseline had a higher chance to perceive having a better or at least the same OHRQoL at the 2-month and 1-year follow-ups, respectively.

CONCLUSIONS

The ODCP in Hong Kong can solve some of the dental problems of older adults using long-term care services and keep most of them from deterioration in OHRQoL, especially those suffering from toothache.

Teledentistry and Forensic Odontology: Qualitative Study on the Capacity of Implementation

The postmortem identification of people without an identity is performed either by using DNA, dental charts, or fingerprints (until advanced decomposition prevents their study). The lack of forensic dentists who can conduct identifications lead us to reflect on the use of digital technology in this area. The aim of this study was to validate the organizational capacity of using teledentistry for the identification of bodies in a forensic medicine department. A mixed observational study was conducted on 55 cases between July 2020 and February 2021 in the Forensic Medicine and Thanatology Department of Montpellier University Hospital. The protocol was structured in five steps: an initial interview with the agent (a forensic autopsy technician/caregiver specialized in forensic medicine), regarding the idea they had in terms of using telemedicine in their daily practice; agent training in the telemedicine system; realization of a clinical examination using an intra-oral camera by the agent; data analysis by a dental surgeon; final interview with the agent. The study was conducted on 55 subjects. The average age was 54 years old, with more than two-thirds of the patients being male (69%). The videos had an average duration of 29 min. There was an increase in visit duration when rigidity was high; this was also the case when there were many dental specificities in the oral cavity. The quality of the videos was either good or excellent. This study showed that remote identification could be considered as a new non-invasive identification tool. Many features were analyzed to create a training guide for forensic institutes.

An extraoral approach to intraoral cooling-a feasibility study in non-cancer patients

BACKGROUND

Cryotherapy, using ice chips (IC) is an effective strategy to prevent chemotherapy-induced oral mucositis (OM) in selected cancer patient cohorts. However, although effective, use of IC may cause adverse reactions, e.g., nausea, numbness, and shooting pain in the teeth, which could have an adverse impact on the medical treatment. Furthermore, IC requires water of good quality to minimize risk of serious systemic infections. To eliminate these disadvantages, novel cooling devices have emerged as alternative cooling modalities. Thus, the aim was to evaluate the efficacy and tolerability profile of extraoral cooling for intraoral temperature reduction.

SUBJECTS AND METHODS

This experimental pilot study was conducted at the Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. In total, six healthy volunteers were enrolled in this study. At baseline and following 30-, and 60 min of cooling with the extraoral cooling device, intraoral mucosal temperatures were measured using a thermographic camera, and a questionnaire related to tolerability was completed.

RESULTS

Following 30-, and 60 min of cooling, the intraoral temperature decreased with 2.0 °C and 2.3 °C, respectively. Extraoral cooling was well tolerated, and all subjects endured the entire cooling session of 60 min.

CONCLUSION

Extraoral cooling reduces intraoral mucosal temperatures and is a well-tolerated cooling modality.

The national child odontology registry (SCOR): a valuable resource for odontological and public health research

BACKGROUND

Since 1972 The National Child Odontology Registry has collected data on the oral health of most of all Danish children and adolescents. However, comprehensive information on the registry has not previously been available, making it difficult to approach and use the registry for research purposes.

METHODS

By combining historical documentation and simple descriptive statistics we provide an overview of major events in the timeline of The National Child Odontology Registry and discuss how they impact the available data. We provide a broad overview of the dental variables in the registry, and how the registration criteria for some of the core dental variables (gingivitis, periodontitis, and dental caries) have changed over time. We then provide examples of how aggregate variables for the core dental diseases, allowing for comparison across registration criteria, can be created.

RESULTS

Most of the Danish population born during or after 1965 have a least one entry in the National Child Odontology Registry, with 68% having entries spanning their entire childhood and adolescence. The prevalence of gingivitis and periodontitis seem to increase significantly in the years immediately following changes in how registration criteria for these variables, raising questions as to whether these diseases are generally underreported, or subject to overreporting in the years following the registration changes. The mandatory ages of registration instituted in 2003, do not appear to have had a strong impact on the ages at which registrations are made. For variables not directly comparable across datasets due to changes in registration criteria aggregate variables of measurements can be computed in most cases.

CONCLUSIONS

The National Child Odontology Registry provides a unique opportunity to study the impact of childhood oral health on life trajectories, but using the registry is not without issues, and we strongly recommend consulting with experts in the field of odontology to ensure the best use of available data.

[Prevalence of dental and mucosal lesions among the pediatric population who attended the emergency department of a general hospital]

BACKGROUND

The high prevalence of oral pathology in children encourages to gain further understanding on their manifestations and urgent nature, objective of the present study Methodology. Cross-sectional study that included patients aged <14 years of age who attended an emergency department over a one-year period. The relationship between the variables collected and oral pathology was analyzed.

RESULTS

Fifty-five patients were included, 45.5% girls, mean age 4.11 years (10 days to 13 years). Overall, mucosal pathology (74.5%) prevailed over dental ones, and lesions of infectious origin (54.6%) over the traumatic ones (14.5%). Dental pathology (50% toothache and 35.7% infections) was significantly associated with being >6 years (66.7 vs 10%), pain (40.7 vs 10.7%) and absence of fever (37.9 vs 11.5%). Mucosal pathology (61% infections: 53.7% viral and 31.7% due to herpangina) was significantly associated with being =6 years (60 vs 6.7%) and having fever (76.9 vs 17.2%). Six traumatic lesions on the mucosa and two on the teeth were observed; significantly more patients attended the emergency room within 24 hours (median =1 hour) than in the case of infection (100 vs 51.7%). Being =6 years was significantly associated with fever, mucosal pathology, mucosal infection, and herpangina, and being >6 years was associated with pain, previous antibiotic treatment and at discharge, and previous NSAID regimen.

CONCLUSIONS

The analyzed pediatric oral pathologies treated in the emergency department are of mucosal and infectious origin. Dental disease prevail in children >6 years of age and mucosal lesions in those =6 years; no sex differences are observed.

Self-Medication for Toothache Causing Chemical Burn of Oral Mucosa and Alveolar Bone Loss in a Child

Chemical burn of the oral mucosa can occur as a result of the inadvertent, intentional or iatrogenic use of chemicals. Self-treatment for toothache relief with nonpharma ceutical substances can result in a chemical burn. A detailed history is paramount in such cases to identify the etiologic agent to proceed with appropriate treatment. The purpose of this report is to describe the case of an eight-year-old with a complaint of toothache who rinsed his mouth with potassium aluminium sulfate solution to achieve pain relief. This caused ulceration of the attached gingiva and oral mucosa and necrosis of the alveolar bone surrounding the offending tooth, leading to its mobility. This case highlights the disastrous consequences of inappropriate self-treatment to achieve pain relief from toothache.

Physical intimate partner violence and oral health problems during pregnancy

BACKGROUND

The aim of this study was to assess the association between physical intimate partner violence (IPV) during pregnancy and reports of prenatal oral health problems among a sample of mothers in the United States.

METHODS

Data were obtained from the Pregnancy Risk Assessment Monitoring System from 7 sites (Kentucky, Mississippi, New Hampshire, New York, Puerto Rico, Utah, West Virginia) for 2016 through 2020. The authors used multivariable logistic regression to examine the relationship between physical IPV and respondent self-reports of whether they needed to see a dentist for several oral health problems during pregnancy: (1) needing to have a tooth restored; (2) painful, red, or swollen gingivae; (3) toothache; (4) needing to have a tooth extracted; (5) having an injury to the mouth, teeth, or gingivae; or (6) another problem with teeth or gingivae.

RESULTS

Women who experienced physical IPV during pregnancy had elevated rates of oral health problems during pregnancy compared with women who did not experience IPV. The findings detailed associations between physical IPV and oral health problems that may stem from physical violence, including painful, red, or swollen gingivae; toothache; and mouth, teeth, or gingivae injury.

CONCLUSIONS

The results of this study highlight a connection between physical IPV during pregnancy and oral health problems consistent with orofacial injuries.

PRACTICAL IMPLICATIONS

The association between physical IPV and elevated rates of oral health problems and orofacial injuries highlights the critical role of oral health care providers in screening for, detecting, and intervening in IPV among pregnant women.

Dental tourism and the risk of barotrauma and barodontalgia

Background and aim Dental tourism, which reflects the provision of health care services abroad, also includes a travelling component. Air travel after dental intervention may cause barotrauma and barodontalgia. This paper aimed to provide guiding principles regarding the minimal time interval between dental procedures and air travel to prevent these adverse effects.Methods A literature search was performed to reveal information with regards to complications related to flights following dental treatments. There is little research in this area and most of it has been conducted on the military aircrew population, which has different characteristics of flight and personnel than civilian commercial flights.Results The recommended time of flying is one week after most dental intervention and six weeks after a sinus lift procedure. The minimal time required between a procedure and flight is 24 hours after restorative treatment, 24-48 hours after simple extraction, 72 hours after nonsurgical endodontic procedure, surgical extraction, and implant placement, and at least two weeks after sinus lift procedure.Conclusions The provided guidelines may serve as a starting point for the clinician's decision-making. The tailoring of an individual treatment plan to the patient should take into consideration the patient's condition, dental procedure, complications and flight characteristics. Further research based on commercial flights is needed to formulate more accurate guidelines for the civilian population.

Upregulation of TACAN in the trigeminal ganglion affects pain transduction in acute pulpitis

OBJECTIVE

Acute pulpitis is one of the common causes of tooth pain. TACAN (Tmem120a) is a newly identified ion channel that senses mechanical pain. In this experiment, we studied the expression of the TACAN ion channel in the trigeminal ganglia in a rat model of pulpitis to explore the correlation between the expression of this ion channel and inflammatory pain.

DESIGN

Lipopolysaccharide was used to induce acute pulpitis in rats, and pulpitis was assessed histologically. The facial pain threshold of the rats was measured by the von Frey test. TACAN mRNA expression in rat dental pulp and the trigeminal nerve was measured by qPCR, and TACAN protein expression in the trigeminal ganglia was evaluated by western blot analysis and immunofluorescence. Antisense oligonucleotides were used to reduce TACAN protein expression in the trigeminal ganglia, and the change in the pain threshold in the rats with acute pulpitis was determined.

RESULTS

The results showed that the TACAN transcript level in rat pulp tissue increased under inflammatory conditions, and we proved that pulpitis increased TACAN protein expression in the rat ipsilateral trigeminal ganglia. The facial pain threshold was decreased in rats with pulpitis. A short-term decrease in TACAN protein expression could improve the pain threshold.

CONCLUSIONS

With the development of pulpitis after bacterial infection, the upregulation of TACAN expression in the trigeminal ganglia promoted pain sensitivity. A short-term reduction in TACAN expression relieved pain. Therefore, this study indicated that TACAN is a potential target channel for new analgesics.

Evaluation of the in vitro and in vivo anti-inflammatory activity of Gymnosporia montana (Roth). Benth leaves

ETHNO-PHARMACOLOGICAL RELEVANCE

Gymnosporia montana (Roth) Benth an herbaceous shrub used in Indian traditional medicine their leaves decoction was used as mouthwash to get relieve from toothache, hence it is also known as Dantakashta in Sanskrit language which means the plant used for tooth problems. Traditionally the leaves juice used to alleviate inflammation and in some parts of India like Saurashtra in Gujarat, leaves were chewed as a folklore cure for Jaundice and in Bhandra region Karnataka, leaves extract mixed with cow milk used for jaundice. Hepatoprotective activity for G. montana leaves was well reported however, its use for inflammation and toothache are still not studied to investigate active phytoconstituents responsible for anti-inflammatory activity.

AIM OF THE STUDY

The present study aimed at bioactivity guided isolation of G. montana leaves extracts using inhibition of pro-inflammatory mediators such as nitric oxide (NO), tumor necrosis factor (TNF-α), and interleukins (IL-1β and IL-6) in RAW 264.7 cells in vitro assay to yield bioactive phytoconstituents.

MATERIALS AND METHODS

The n-hexane, ethyl acetate and methanol extracts prepared from G. montana leaves were evaluated for cell viability using MTT assay. The effect of extracts to inhibit the pro-inflammatory mediators like NO, TNF-α, IL-1β and IL-6 in RAW 264.7 macrophages was measured by enzyme-linked immunosorbent assay (ELISA). The quantitative analysis of the isolated phytoconstituents was performed using quantitative Nuclear Magnetic Resonance (qNMR).

RESULTS

The n-hexane, ethyl acetate, and methanol extracts of G. montana leaves exhibited cell viability in the range of 97.43-84.88% at 50 μg/mL concentration in RAW 264.7 macrophages. In-vitro evaluation of extracts showed that n-hexane extract was most effective in inhibiting NO, TNF-α, IL-1β and IL-6 inflammatory mediators at 50 μg/mL in lipopolysaccharides (LPS) stimulated RAW 264.7 cells. Further n-hexane extract, its fraction GMHA3 and β-amyrin exhibited significant anti-inflammatory activity at 100, 50 and 30 mg/kg per oral, respectively in carrageenan-induced rat paw edema. The quantitative analysis by qNMR revealed β-amyrin as a major compound in the n-hexane extract.

CONCLUSIONS

In vitro and in vivo bioassay results suggested that G. montana n-hexane extract, its fraction GMHA3 and β-amyrin exhibits significant anti-inflammatory activity proves the traditional uses of G. montana leaves. The reported activity of β-amyrin for periodontitis provides evidence of profound the use of G. montana leaves for toothache and anti-inflammatory activity.

Social economic disadvantage and dental caries: findings from a cohort study in adolescents

This study aimed to assess the impact of determinants of the individual and contextual level on the untreated dental caries during adolescence. A cohort study was started in 2012 with a random sample of 1,134 12 years-old adolescents in the city of Santa Maria, RS, Brazil. The adolescents were clinically evaluated by calibrated dentists and investigated variables: contextual, demographic, socioeconomic factors, dental service use, toothache, and subjective variables. After two years (T2) and six years (T3), the same adolescents were reevaluated (retention rate of 67.9% and 67.8%, respectively). Untreated dental caries (component "D" of the DMFT index) was the outcome and was collected at all three times. Multilevel Poisson regression analyses considered repeated measures (level 1 - times), nested to adolescents (level 2), were used to assess the association between predictors (baseline) and untreated dental caries. High neighborhood' mean income was associated with the lowest risk of dental caries. Low household income [Incidence Rate Ratio (IRR) 1.57; Confidence Interval (CI) 95% 1.35-1.82], low mother education (IRR 1.19; CI95%1.03-1.38), toothache (IRR 1.73; CI95% 1.47-2.03), gingival bleeding (IRR 1.23; CI95% 1.05-1.45), and poor self-perception of oral health (IRR 1.19; CI95% 1.07-1.32) were risk factors for untreated dental caries. In conclusion, our results showed that socioeconomic disadvantages and oral conditions in early adolescence are risk factors for untreated caries among adolescents.

Development and Initial Validation of the Oral Health Activities Questionnaire

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

Disparities in Caregiver-Reported Dental Cavities and Toothaches Among Children in the Special Supplemental Nutrition for Women, Infants, and Children (WIC) Program

Purpose: Dental caries is prevalent among low-income and minority children despite oral health promotion programs. The purpose of this study was to examine disparities associated with caregiver-reported cavities and toothaches among children in the United States aged 2-4 years by their eligibility for and participation in the Special Supplemental Nutrition for Women, Infants, and Children (WIC) program.Methods: A secondary data analysis was performed using the 2016 National Survey of Children's Health (NSCH) data on children aged 2-4 years (n=7,719) with complete WIC participation information. Three groups were formed based on WIC eligibility and participation status: WIC participants, income-eligible non-participants, and higher-income non-participants. Caregiver-reported cavities and toothaches were compared by WIC eligibility and participation using chi-square tests and multivariate logistic regression analysis.Results: Among all children in the data set, 2,069 were WIC eligible, 49.8% of whom participated in WIC. Participants in WIC had higher reported cavities and toothaches (10.0% and 5.2%) than income-eligible, or higher-income non- WIC participating children (8.9% and 3.2%; 4.4% and 0.1%, respectively; p < 0.001). However, non-Hispanic, white WIC participants, had a higher proportion of reported cavities (14.0%) and toothaches (8.2%) than income-eligible non-participants (6.7% and 1.9%, respectively; p < 0.05). While non-Hispanic, black WIC participating children, had nearly 3.6 times more reported cavities than income-eligible nonparticipants (9.0% vs. 2.5%, p < 0.05).Conclusion: Caregiver-reported cavities and toothaches varied by sociodemographic characteristics within WIC participation and eligibility groups. These findings suggest that more research is warranted to explore factors that are contributing to oral health disparities associated with WIC eligibility and participation.

[Changes of dental emergency cases in the first half from 2017 to 2020 in Shanghai Ninth People's Hospital]

PURPOSE

This study aimed to summarize and analyze dental emergence data and compare with the same period from 2017 to the first half of 2020, to provide a basis for improving the quality of dental emergency care and formulating rational allocation.

METHODS

A total dental emergency cases from 2017 to the first half of 2020 were collected, statistical analysis was carried out according to patients' sex and age, chief complaints and diagnosis with SPSS 18.0 software package.

RESULTS

The top three diseases in 2017 of dental emergency were maxillofacial trauma, facial infection and dental pulp disease. From 2018, most of the specialized patients were treated due to oral craniomaxillofacial injury , maxillofacial infection and tumors. The top three chief complaints for 3 consecutive years were facial swelling, toothache and dental trauma. The difference of emergency data within 4 years was statistically significant.

CONCLUSIONS

There are a large number of patients which follow the regular pattern and a wide scope of disease types in dental emergency department. The total amount has a rising trend year by year. After divisions of dental emergency department are established, the patients' treatment is more timely, convenient and targeted, and the quality of medical service has been improving.

Is the Quality of Toothache-Related Information Published in Brazilian Websites Adequate to Assist People in Seeking Dental Treatment?

PURPOSE

The aim of this study was to evaluate the readability and the quality of toothache-related information found in Brazilian websites.

MATERIALS AND METHODS

Fifty-five websites retrieved from Google Search, Baidu, Yahoo! and Bing were evaluated by two independent examiners using the DISCERN questionnaire, the Journal of American Medical Association (JAMA) benchmark criteria and the Flesch Reading Ease adapted to Brazilian Portuguese (FRE-BP). Additionally, the websites were categorised according to their information, adopting four criteria related to: (i) endodontic pain, (ii) toothache relief or treatment, (iii) the self-resolution of pain, and (iv) the promotion of home remedies usage. The statistical analysis was performed using Spearman's rank correlation coefficient, Mann-Whitney U test, hierarchical clustering analysis by Ward's minimum variance method, Kruskal-Wallis test, post-hoc Dunn's test and Chisquare test. P < 0.05 was considered statistically significant.

RESULTS

The overall means (± SD) of DISCERN and FRE-BP were, respectively, 31.02 (± 5.56) and 61.20 (± 11.79), without quality-based differences between the websites with health- and non-health-related authors, and distinct clusters.

CONCLUSION

Therefore, the quality of toothache-related information found in this sample of Brazilian websites was classified as simple, accessible and of poor quality, which can hamper the personal decision-making process of seeking dental treatment, leading to damages caused by the non-effective self-management of toothache.

Dental Pain in Preschool Children Using the Brazilian Dental Discomfort Questionnaire and its Association with Dental Caries and Socioeconomic Factors

Purpose: To assess the prevalence of dental pain in preschool children through the Brazilian Dental Discomfort Questionnaire (DDQ-B) and its association with dental caries, its severity, and socioeconomic factors. Methods: The study included 485 three- to four-year-olds who attended the National Day of Children's Vaccination in São Paulo, Brazil. Parents answered the DDQ-B and questions of socioeconomic conditions. Calibrated dentists assessed dental caries using the decayed, missing, and filled primary teeth (dmft) index and its severity using the pulpal involvement, ulceration of mucosa due to root fragments, fistula, and abscess (PUFA) index. Poisson regression with robust variance was used with a level of significance of five percent. Results: The prevalence of dental pain was 11.8 percent. Dental pain was associated with a prevalence of dental caries (prevalence ratio [PR] equals 2.47; 95 percent confidence interval [95% CI] equals 1.33 to 4.58; P=0.004) and severe caries (PR equals 2.98; 95% CI equals 1.39 to 6.39; P=0.005). Socioeconomic factors were not associated with dental pain. Conclusions: The prevalence of dental pain in preschool children is relevant when assessed through the Brazilian Dental Discomfort Questionnaire. Dental pain is associated with dental caries prevalence and its severity. Socioeconomic factors were not associated with dental pain.

Primary diffuse large B-cell lymphoma of mandible masquerading as a toothache

Diffuse large B-cell lymphoma is an aggressive, fast-growing form of non-Hodgkin disease with rare manifestation in mandible as a primary site. Absence of pathognomonic features in this localization often leads to misdiagnosis as an odontogenic process or its delayed diagnosis. The present case report is of a patient in whom non-odontogenic jaw pain mimicked a toothache prompting multiple dental interventions before persistence of pain and atypical findings led to consideration of a primary malignant etiology.

Myofascial pain with referral from the anterior digastric muscle mimicking a toothache in the mandibular anterior teeth: a case report

BACKGROUND

Non-odontogenic toothaches often present as a diagnostic dilemma to clinicians. Myofascial pain with referral from the trigger points in the masticatory muscles are one of the common causes of non-odontogenic toothaches. However, there are limited reports of myofascial pain from the anterior digastric muscle referring pain to the mandibular anterior teeth and mimicking odontogenic pain.

CASE PRESENTATION

A case of non-odontogenic toothache in the mandibular anterior teeth due to myofascial pain with referral from trigger points in the anterior digastric muscle is presented. The patient had significant relief with a trigger point injection of the anterior digastric muscle. Amitriptyline 10 mg once daily was prescribed for 1 month. In addition, she was advised home care instructions to control predisposing, perpetuating, and precipitating factors, and given home care exercises, a hard joint stabilization splint, physiotherapy, and postural re-education.

CONCLUSION

Non-odontogenic toothaches may be multifactorial. The case presented emphasizes the importance of a comprehensive evaluation to differentiate odontogenic pain from non-odontogenic pain. Irreversible dental procedures should be instituted after an accurate diagnosis and multidisciplinary management may be required in complex cases.

Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling: A report from the American Dental Association

BACKGROUND

An expert panel convened by the American Dental Association Council on Scientific Affairs and the Center for Evidence-Based Dentistry conducted a systematic review and formulated clinical recommendations for the urgent management of symptomatic irreversible pulpitis with or without symptomatic apical periodontitis, pulp necrosis and symptomatic apical periodontitis, or pulp necrosis and localized acute apical abscess using antibiotics, either alone or as adjuncts to definitive, conservative dental treatment (DCDT) in immunocompetent adults.

TYPES OF STUDIES REVIEWED

The authors conducted a search of the literature in MEDLINE, Embase, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature to retrieve evidence on benefits and harms associated with antibiotic use. The authors used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty in the evidence and the Evidence-to-Decision framework.

RESULTS

The panel formulated 5 clinical recommendations and 2 good practice statements, each specific to the target conditions, for settings in which DCDT is and is not immediately available. With likely negligible benefits and potentially large harms, the panel recommended against using antibiotics in most clinical scenarios, irrespective of DCDT availability. They recommended antibiotics in patients with systemic involvement (for example, malaise or fever) due to the dental conditions or when the risk of experiencing progression to systemic involvement is high.

CONCLUSION AND PRACTICAL IMPLICATIONS

Evidence suggests that antibiotics for the target conditions may provide negligible benefits and probably contribute to large harms. The expert panel suggests that antibiotics for target conditions be used only when systemic involvement is present and that immediate DCDT should be prioritized in all cases.

Factors associated with children's perception of pain following dental treatment

PURPOSE

To assess children's perception of pain during routine dental procedures and associated factors.

METHODS

A cross-sectional study was performed including 192 children aged 6-13 years, who visited a university paediatric dental clinic. Mothers were interviewed to obtain information about demographic and socioeconomic data, and psychosocial characteristics. During dental treatment, children's behaviour was assessed using Frankl's Behaviour Scale. Dental procedures were recorded according to complexity of treatment from dental records. Immediately after the dental procedure, perception of pain was assessed using the Faces Pain Scale-Revised. Poisson regression analysis was used to assess the association between potential predictor variables and perception of pain (P  < 0.05 was considered significant).

RESULTS

Overall, the mean pain score was 1.5 (SD 2.4). Higher levels of pain were reported by children who demonstrated non-cooperative behaviour during the treatment (RR = 2.39, 95% CI = 1.23-4.64), who were administered local analgesia (RR = 2.36, 95% CI = 1.31-4.27), and who reported dental pain during the previous 4 weeks (RR = 1.60, 95% CI = 1.04-2.47).

CONCLUSION

Perception of pain may be influenced by pre-operative pain and use of local analgesia, and is associated with non-cooperative behaviour during treatment.

Dental Pain: Dentine Sensitivity, Hypersensitivity and Cracked Tooth Syndrome

Dentine hypersensitivity is a frequently encountered patient complaint that can present with a number of associated factors including erosion and abrasion. the hydrodynamic mechanism responsible for dentine hypersensitivity is intimately related to the anatomical and physiological composition of teeth. Alterations to the integrity of the enamel and dentine through processes of trauma, decay and toothwear can increase dentine permeability. This gives rise to symptoms of sensitivity as dentinal fluid movement in response to thermal, chemical and mechanical cues stimulate the pulpal Aδ fibres. Restorative procedures can also rapidly change the architecture of the protective enamel and dentine layers leading to pulpal inflammation and increased thermal sensitivity of the tooth.<br/> Patient-reported symptoms of dentine hypersensitivity can be attributed to a number of possible causes and a definitive diagnosis can therefore be difficult. A full history including social and medical factors such as occupation, diet and/or medication is likely to provide significant information to aid a diagnosis. Consideration of occlusal factors should not be overlooked as these may contribute to symptoms arising from a cracked tooth.<br/> Management strategies are linked to the diagnosis - from topically applied desensitising pastes and resin bonding agents to direct restorations and possibly more advanced restorative procedures such as root canal treatment. Management should, however, be staged to enable more conservative strategies to prevail prior to considering irreversible dental interventions.

The influence of clinical and psychosocial characteristics on children behaviour during sequential dental visits: a longitudinal prospective assessment

PURPOSE

This is the first study to adopt a multilevel approach to assess the impact of the order of dental visits on child's behaviour. The aim was to investigate which factors directly interfere with child's behaviour regardless of the order of sequential dental visits.

METHODS

In this prospective longitudinal study, children aged 7-12 years were invited to participate. Child behaviour was assessed using the Frankl Scale during four sequential dental visits. Chi-square test was used to analyse the effect of dental fear on children's non-cooperative behaviour according to the presence of dental fear. Multilevel mixed logistic regression model was used to assess the association between predictor variables and the outcome (child behaviour) during the sequential dental visits.

RESULTS

Overall, 111 children participated in this study. Maternal dental anxiety, dental pain and complexity of the treatment were associated with the non-cooperative behaviour in children aged 7-12 years. When stratified by dental fear, the complexity of the treatment remained associated with non-cooperative behaviour.

CONCLUSIONS

The results provide evidence that, even with the familiarization of child with the dental environment, maternal dental anxiety, dental pain in the last month, and the complexity of dental treatment negatively affect the children's behaviour aged 7-12 years.

Perceived impact of dental pain on the quality of life of children aged 1-3 years and their families

PURPOSE

To evaluate the perceived impact of dental pain on oral health-related quality of life (OHRQoL) among children aged 1-3 years and their families.

METHODS

A cross-sectional study was conducted with 306 randomly selected preschool and day care children in the city of Diamantina, Brazil. Parents/caregivers answered a questionnaire on socio-demographic information, the Brazilian version of the Early Childhood Oral Health Impact Scale, their child's general/oral health and the Brazilian version of the Dental Discomfort Questionnaire. The children underwent an oral examination. Descriptive statistics, Spearman's correlations, the Kruskal-Wallis test, Mann-Whitney test and Poisson regression were used to determine associations between the variables (prevalence ratio [PR], α = 5%).

RESULTS

The prevalence of dental caries and dental pain was 43.1% and 40.2%, respectively. Dental pain (PR: 1.96, 95% CI 1.52-2.54; p < 0.001), monthly household income (PR: 1.38, 95% CI 1.04-1.83; p = 0.026) and dental caries (PR: 1.06, 95% CI 1.03-1.10; p < 0.001) were significantly associated with the perceived impact on OHRQoL.

CONCLUSIONS

Dental pain, household income and dental caries were associated with a negative impact on the OHRQoL of children aged 1-3 years and their families.

Comparative Study of Dental Pain Between Children With and Without a History of Maltreatment

AIMS

To assess the presence of dental pain in child abuse victims and to compare the findings to children in the same age group with no history of abuse in a Southern Brazilian city.

METHODS

This cross-sectional comparative study was carried out in a convenience sample of 68 child abuse victims from a center for psychologic support and in a comparative group of 204 students from public and private schools, all aged between 8 and 12 years. Data for socioeconomic and demographic variables were collected, and information regarding dental pain in the last 6 months was obtained via interviews with the children. World Health Organization criteria were used to assess the presence of decayed, missing, or filled teeth in primary and permanent dentition. Dental trauma was measured using the O'Brien Index, and gingival bleeding was assessed. Crude and adjusted logistic regression analyses were performed to assess the association between dental pain and history of abuse.

RESULTS

Reporting of dental pain was higher among child abuse victims (54.41%) than in the comparative group (36.14%) (P < .01). After adjustment for clinical variables in the logistic regression analyses, the child abuse victims group had an odds ratio of 2.03 (95% confidence interval 1.13 to 3.64) for dental pain (P = .01).

CONCLUSION

Child abuse victims presented a higher prevalence of dental pain than children with no history of maltreatment, regardless of oral health status.

Introduction to Pain

This edition of PDJ is intended to provide a wide overview on orofacial pain for dental and medical teams. Both acute and chronic orofacial conditions relevant to dentistry and medicine will be covered, and emphasising a holistic and pragmatic approach. Orofacial pain is the most common presenting symptom for patients presenting to their dentist and increasingly commonly presenting to doctors in general practice and A&E departments.<br/> Pain in the trigeminal system causes much higher psychological and neurophysiological distress compared with other body regions, as the trigeminal nerve is the great sensory protector to the eyes, ears, nose, mouth and meninges, the senses that underpin our very existence. It is an anathema that surgery in and around the face and mouth is predominantly undertaken by dentists on conscious patients, unlike other surgical specialties. This explains the expectation of pain by patients when seeing their dentists, sadly an expectation which is frequently fulfilled, fuelling high levels of anxiety and fear, which in turn increases the pain experience.

Mark Twain's Affection for Toothache

About 30 years ago, I encountered in a rare book dealer's catalog, a six-page autographed Mark Twain letter of 5 April 1884, offered for several thousand dollars. Mr. Clemens commented in the letter how much affection he had for letter-writing (sic). That comment intrigued me, but I did not have the several thousand dollars asking price. The seller was most gracious when I related that I was a dentist and offered to purchase a photocopy of the letter. He supplied me with that photocopy with no fee attached. I filed the photocopy away and it recently resurfaced in my papers.

Dental care seeking behaviour of children in a rural Nigerian community

BACKGROUND

There is sparse information about oral health seeking behaviour of children in rural areas of developing countries. The aim of the Study was to determine the dental care seeking-behaviour of children attending the first rural based community oral health centre in Nigeria.

METHODS

A retrospective review of records of patients aged 16 years or younger treated at the Primary Oral Health Care Centre in Ibarapa, Nigeria over six years was conducted. Data on sociodemographic characteristics of the patients, pattern of presentation and their oral hygiene practices were collected and processed using SPSS.

RESULTS

A total of 239 paediatric patients were seen during the period with a mean age of 9.7 ± 4.4 years and 132 (55.2%) were males. The majority, 225 (94.1%), were presenting for the first time. All the children sought dental care for one problem or the other and the most common reasons for seeking care were: tooth ache in 105 (43.9%), trauma in 30 (12.6%) and perceived unclean mouth in 20 (8.4%) patients. Older children were more likely to seek dental care because of pain (p < 0.00 1), while younger children sought care principally on account of trauma (p < 0.001) and the under 5 years were seen more often for gum ache (p =0.006). The majority, 175 (73.2%), used toothbrush and 182 (76.2%) cleaned their teeth once daily.

CONCLUSION

None of the children presented for routine check-up, rather, consultation was as a result of dental problems with toothache being the most common reason.

Evaluation of internet search trends of some common oral problems, 2004 to 2014

OBJECTIVE

Internet search trend volumes can provide free, fast and pertinent information about peoples' online interests. No study has yet been conducted on internet search trends in dentistry. This study aims to investigate ten years' data on internet search volumes regarding some oral problems: "toothache", "tooth decay", "gum disease", "wisdom teeth" and "oral cancer". The study also aims to investigate the most common geographic search locations and to examine related searches.

RESEARCH DESIGN

Worldwide intermet search trend data over a period of 532 weeks (4 January 2004 and 15 March 2014) retrieved from the Google Trends web site was interrogated for each search term to identify search trends, regional interests, and related searches.

RESULTS

The search volumes for the terms "toothache "and "wisdom teeth" increased over the decade while "tooth decay", "gum disease", and "oral cancer" showed slight changes. Each term was most commonly searched in different counties: "toothache", Philippines; "tooth decay", Singapore; "Gum Disease", Ireland; "Wisdom Teeth", United States; and "Oral cancer", India. Related searches were mainly focused on symptoms and remedies of these problems.

CONCLUSIONS

Regional and time-related variations in search volumes may provide dental professionals with readily- and freely-available pertinent information on populations' internet searches regarding dental complaints.

Anxiety and pain during dental treatment among children with haemophilia

AIM

Dental interventions are potentially overwhelming for children with hemophilia; the study was designed to assess the levels of dental anxiety related to the first dental intervention for these children.

MATERIALS AND METHODS

Fifty-six boys with severe haemophilia A and B and 56 healthy peers between the ages of 7-12 in need of primary dental extraction were chosen for this study. Facial Analog Scale and Visual Analog Scale were applied to all participants.

RESULTS

No significant differences among the groups were detected by means of the dental anxiety scores (FIS) and pain scores (VAS). The FIS scores of children who had experienced dental pain before the treatment were significantly higher regardless of the group they were part of (p=0.001).

CONCLUSION

Children with haemophilia are not at an increased risk of dental anxiety using special precautions and with the help of adequate treatment regimens. Pain is a predictor for dental fear and anxiety on dental chair both for children with haemophilia and healthy ones.

Mozart: the toothache of a genius

The medical history of Wolfgang Amadeus Mozart (1756-1791) has been pieced together from his letters and from anecdotes, but his dental health is one aspect which has been somewhat overlooked. It is known that, from an early age, he suffered from toothache and tooth abscesses, problems that may even have had other medical repercussions. In this paper, the authors explore and consider whether these negative experiences might have influenced Mozart's work and his attitude to teeth and dental pathologies. Two pieces of evidence from the life and work of this great composer provide clues: the aria entitled "A tooth decayed and sensitive to cold" (KV 209 a) (1772), containing the lament of a "sick man" suffering from toothache; and the first of the "Zoroastrian Riddles," which Mozart proposed during a masked ball in 1786, and whose solution is "teeth." Close examination of these two creative feats demonstrate that Mozart's attitude toward dental pathologies was calm and rational, so much so that he even managed to use the topic as a source of inspiration for a small jewel of a composition.

Clinical and Radiographic Assessment of Various Predictors for Healing Outcome 1 Year After Periapical Surgery

This clinical study prospectively evaluated the influence of various predictors on healing outcome 1 year after periapical surgery. The study cohort included 194 teeth in an equal number of patients. Three teeth were lost for the follow-up (1.5% drop-out rate). Clinical and radiographic measures were used to determine the healing outcome. For statistical analysis, results were dichotomized (healed versus nonhealed). The overall success rate was 83.8% (healed cases). The only individual predictors to prove significant for the outcome were pain at initial examination (p=0.030) and other clinical signs or symptoms at initial examination (p=0.042), meaning that such teeth had lower healing rates 1 year after periapical surgery compared with teeth without such signs or symptoms. Logistic regression revealed that pain at initial examination (odds ratio=2.59, confidence interval=1.2-5.6, p=0.04) was the only predictor reaching significance. Several predictors almost reached statistical significance: lesion size (p=0.06), retrofilling material (p=0.06), and postoperative healing course (p=0.06).

Vasospastic angina in a 13-year-old female patient whose only symptom was toothache

Vasospastic angina was confirmed in a 13-year-old female patient at autopsy. The patient's only symptom was recurrent toothache, which began when she was 10 years old. In November 2000, she was evaluated at our medical center; however, all examinations were judged normal. Six months later, she suffered a severe toothache. She went to school the next morning after the symptoms improved. She lost consciousness at school and was given cardiopulmonary resuscitation but could not be revived. At autopsy, her three coronary vessels showed marked intimal hyperplasia, and multiple focal myocardial infarctions were observed in the lateral wall of the left ventricle. The patient's only clinical symptom was toothache and none of the physicians realized that this was caused by angina. Vasospastic angina begins at a young age and is one of the causes of sudden death in adolescents.

The oral health assessment tool--validity and reliability

BACKGROUND

The Oral Health Assessment Tool (OHAT) was a component of the Best Practice Oral Health Model for Australian Residential Care study. The OHAT provided institutional carers with a simple, eight category screening tool to assess residents' oral health, including those with dementia. This analysis presents OHAT reliability and validity results.

METHODS

A convenience sample of 21 residential care facilities (RCFs) in urban and rural Victoria, NSW and South Australia used the OHAT at baseline, three-months and six-months to assess intra- and inter-carer reliability and concurrent validity.

RESULTS

Four hundred and fifty five residents completed all study phases. Intra-carer reliability for OHAT categories: percent agreement ranged from 74.4 per cent for oral cleanliness, to 93.9 per cent for dental pain; Kappa statistics were in moderate range (0.51-0.60) for lips, saliva, oral cleanliness, and for all other categories in range of 0.61-0.80 (substantial agreement) (p < 0.05). Inter-carer reliability for OHAT categories: percent agreement ranged from 72.6 per cent for oral cleanliness to 92.6 per cent for dental pain; Kappa statistics were in moderate range (0.48-0.60) for lips, tongue, gums, saliva, oral cleanliness, and for all other categories in range of 0.61-0.80 (substantial agreement) (p < 0.05). Intraclass correlation coefficients for OHAT total scores were 0.78 for intra-carer and 0.74 for inter-carer reliability. Validity analyses of the OHAT categories and examination findings showed complete agreement for the lips category, with the natural teeth, dentures, and tongue categories having high significant correlations and percent agreements. The gums category had significant moderate correlation and percent agreement. Non-significant and low correlations and percent agreements were evident for the saliva, oral cleanliness and dental pain categories.

CONCLUSION

The Oral Health Assessment Tool was evaluated as being a reliable and valid screening assessment tool for use in residential care facilities, including those with cognitively impaired residents.

The psychosocial effects of severe caries in 4-year-old children in Recife, Pernambuco, Brazil

The aim of this study was to analyze the psychosocial effects of severe caries in 4-year-old children in Recife, Pernambuco, Brazil. The clinical examination was conducted by a single examiner in order to select children with severe caries and caries-free (kappa = 1). Of the 861 children examined, 77 (8.1%) had severe caries and 225 (23.6%) were caries-free. Data were collected by applying validated questionnaires answered by the parents or guardians. Most of the parents or guardians of children with severe caries reported that their children complained of toothache (72.7%), and a significant portion stated that their children had problems eating certain kinds of food (49.4%) and missed school (26.0%) because of their teeth. Most of the parents or guardians of children with severe caries (68.8%) stated that oral health affects their children's life, while the same was stated by 9.8% of the parents or guardians of the caries-free children. Severe caries was found to have a negative impact on children's oral health-related quality of life.

Autoextraction in a child with autistic spectrum disorder

Many children with mild/moderate autistic spectrum disorder (ASD) receive care in general dental practice. We report a seven year old boy with ASD presenting with dental pain who auto-extracted one of his deciduous canines. Children with ASD may have hyposensitivity to pain and can exhibit unusual forms of self-injurious behaviour.