Barodontalgia during hyperbaric oxygen therapy of an 8-year-old male: A case report

Barodontalgia, barometric pressure-induced dental pain, may occur during hyperbaric oxygen(HBO2) therapy due to pressure changes. This case report presents an 8-year-old male patient with barodontalgia. The patient declared a severe toothache during HBO2 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.

Persistent Toothache Despite Multiple Dental-related Treatments: How Could this Be?

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.

Comparative Analgesia Between Acupuncture and Dipyrone in Odontalgia

The aim of this study was to assess whether the effectiveness of acupuncture is similar to the use of analgesics in the management of toothache. The research included 56 volunteers who were divided into 4 groups: Real Acupuncture group, Placebo Acupuncture group, Real Dipyrone group, and Placebo Dipyrone group. The interventions of the study were performed before the dental care. Inclusion criteria were toothache of pulpal origin with pain scale (Visual Analogue Scale) above 4, absence of medication for the pain, and aged over 18 years. The Real Acupuncture volunteers received a session of acupuncture using piercing needles, while volunteers from the Placebo Acupuncture group received an acupuncture session using non-piercing sham needles. Volunteers from the Real Dipyrone group received a dipyrone tablet and the Placebo Acupuncture group received a tablet with no active ingredient. Before any therapeutic intervention, we collected samples from the volunteers' saliva to analyze the salivary cortisol, the volunteers rated the intensity of their pain using VAS, and we measured their energy level by the Ryodoraku method. After 20 minutes of treatment, all the volunteers' analysis parameters were collected again. The Real Acupuncture group presented a greater reduction of VAS than the reduction obtained by the Real Dipyrone group (p<0.05). There was no statistically significant difference between the groups for the salivary cortisol and energy level variables. It can be concluded that acupuncture was more effective in reducing odontalgia than the dipyrone and that it can be an alternative for odontalgia management.

Managing tooth pain in general practice

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.

Midface migraine with concomitant dental disease: A report of two cases

BACKGROUND

Numerous publications have reported on migraines misdiagnosed as endodontic pathologies. However, reports on the effect that concurrent migraine and endodontic pathology can have on each other and how their respective treatments can also affect each other are limited.

CLINICAL PRESENTATION

Two cases are reported that presented with both migraine and periapical pathology. Patient 1 underwent root canal treatment, which partially alleviated both the migraine and odontalgia. Subsequent treatment with sumatriptan provided additional relief. Patient 2 underwent sumatriptan treatment, with no effect. Subsequent root canal treatment provided significant relief. Patients in both cases have shown continued improvement.

CONCLUSION

Further research is necessary, but the two cases presented suggest that endodontic pathology and migraine symptoms may be associated and endodontic therapy may have an effect on migraine pain.

Put a Frog in Your Mouth: Toothache 'Cures' from Nineteenth- and Twentieth-Century Ireland

During the late nineteenth and early twentieth centuries, toothache must have been a common complaint in Ireland, to judge from the number of toothache 'cures' reported as part of The Schools' Collection (SC) or 'Bailiúchán na Scol', a folklore-collecting scheme that was undertaken in the Irish Republic in 1937 and 1938, and upon which this article is based. These cures range from quasi-medical treatments, such as packing the affected tooth with tobacco, to more folkloric, or magico-religious cures, such as licking a frog or pulling out a tooth from a corpse, as well as herbal and mineral remedies.

Efficacy of orally administered prednisolone versus partial endodontic treatment on pain reduction in emergency care of acute irreversible pulpitis of mandibular molars: study protocol for a randomized controlled trial

BACKGROUND

Irreversible pulpitis is a highly painful inflammatory condition of the dental pulp which represents a common dental emergency. Recommended care is partial endodontic treatment. The dental literature reports major difficulties in achieving adequate analgesia to perform this emergency treatment, especially in the case of mandibular molars. In current practice, short-course, orally administered corticotherapy is used for the management of oral pain of inflammatory origin. The efficacy of intraosseous local steroid injections for irreversible pulpitis in mandibular molars has already been demonstrated but resulted in local comorbidities. Oral administration of short-course prednisolone is simple and safe but its efficacy to manage pain caused by irreversible pulpitis has not yet been demonstrated. This trial aims to evaluate the noninferiority of short-course, orally administered corticotherapy versus partial endodontic treatment for the emergency care of irreversible pulpitis in mandibular molars.

METHODS/DESIGN

This study is a noninferiority, open-label, randomized controlled clinical trial conducted at the Bordeaux University Hospital. One hundred and twenty subjects will be randomized in two 1:1 parallel arms: the intervention arm will receive one oral dose of prednisolone (1 mg/kg) during the emergency visit, followed by one morning dose each day for 3 days and the reference arm will receive partial endodontic treatment. Both groups will receive planned complete endodontic treatment 72 h after enrollment. The primary outcome is the proportion of patients with pain intensity below 5 on a Numeric Scale 24 h after the emergency visit. Secondary outcomes include comfort during care, the number of injected anesthetic cartridges when performing complete endodontic treatment, the number of antalgic drugs and the number of patients coming back for consultation after 72 h.

DISCUSSION

This randomized trial will assess the ability of short-term corticotherapy to reduce pain in irreversible pulpitis as a simple and rapid alternative to partial endodontic treatment and to enable planning of endodontic treatment in optimal analgesic conditions.

TRIAL REGISTRATION

ClinicalTrials.gov, identifier: NCT02629042 . Registered on 7 December 2015. (Version n°1.1 28 July 2015).

[TEAS for prevention and treatment of orthodontic toothache and oral dysfunction: a randomized controlled trial]

OBJECTIVE

To observe the clinical efficacy of transcutanclus electrical acupoint stimulation (TEAS) on prevention and treatment of orthodontic toothache and oral dysfunction.

METHODS

A total of 85 patients of malocclusions in the preliminary diagnosis were randomly divided into a control group (20 cases), a psychological intervention group (22 cases), a medication group (20 cases) and a TEAS group (23 cases). Orthodontics treatment was given in all the groups. Patients in the control group received no further treatment; patients in the psychological intervention group received comprehensive psychological intervention, including cognitive education and music therapy; patients in the medication group received oral administration of ibuprofen; patients in the TEAS group received TEAS at Juliao (ST 3), Jiachengjiang (Extra) and auricular point Ya (LO1). The treatment was given twice a day, one in morning and one at night, for 7 days. The pain scores of orthodontic toothache and changes of oral dysfunction were observed in all groups.

RESULTS

(1) At 5 time points from the 12th hour to the 4th day, the scores of spontaneous pain in TEAS group were lower than those in the control group (all P < 0.01); during the time points, the scores in TEAS group were lower than those in the psychological intervention group (P < 0.05, P < 0.01), which were similar to those in the medication group (all P > 0.05). (2) During the peak cycle of spontaneous toothache, the scores of irritation pain in TEAS group were significantly lower than those in the control group (all P < O.01), regardless of time-point statistics or general statistics; the scores of irritation pain in the TEAS group were also significantly lower than those in the psychological intervention group (all P < 0.01), which were similar to those in the medication group (all P > 0. 05). (3) Compared with control group, the grading of talking disorder in the remaining groups did not change significantly (P > 0.05). (4) Compared with control group, the grading of moderate-severe eating disorder in TEAS group was significantly reduced (P < O.05), which was not different from that in the medication group (P > 0.05). The differences of the grading of moderate-severe eating disorder were not significantly different between the psychological intervention group and control group (P > 0.05). (5) There were 3 cases of digestive system adverse reactions in the medication group.

CONCLUSION

TEAS can efficiently prevent orthodontic toothache and oral dysfunction, which is superior to psychological intervention and similar to medication. In addition, it can avoid possible side-effect of medication.

Ritual tooth modification among the Baka pygmies in Cameroon

INTRODUCTION

Ritual tooth mutilation is a relatively understudied human body mutilatory practices. The purpose of the study was to examine the effects of ritual tooth modification, teeth cleaning measures and herbal medications for their oral health problems among the Baka pygmies in Cameroon.

MATERIALS AND METHODS

This cross-sectional study was conducted between January and March, 2012 using semi-structured questionnaire as the tool of data collection. Intra-oral examinations were carried out to determine the dental hard tissue loss using Smith and Knight Tooth Wear Index (TWI).

RESULTS

Fifty-six pygmies with ritual tooth modification made of 34 males (60.7%) and 22 females (39.3%) with a mean age of 31 years were interviewed and had oral health examination. The reported age at which the tooth modification was done was between 10 and 15 years with mean age as 12 ± 1.66 years. More than half (58.9%) of the participants reported the tooth filing as painful and nearly two-thirds (64.3%) of the participants reported having persistent pain afterwards. The upper right central and lateral incisors were the most commonly modified teeth. A total of 42.9%, 12.5% and 7.1% of the participants had Smith and Knight TWI scores of 2, 3 and 4 respectively. All the participants reported cleaning their teeth at least once-daily with about two-thirds (66.1%) of them doing so with chewing stick. The majority (67.9%) of the participants reported cleaning their teeth for cosmetic reasons [to remove dirt' (60.7%) and 'to remove stains' (7.1%)]. The oral health problems among the participants in form of tooth sensitivity, toothache and dental abscess were treated with plant-based traditional medicines from Irvingia gabonensis, Ricinodendron heudoletti, Pterocarpus soyauxii, Alchornea cordifolia and Piptadeniastrum africanum.

CONCLUSION

Ritual tooth modification is a painful mutilatory practice which is culturally significant for the Baka pygmies without health benefit. There is need for intervention to stop this harmful traditional practices among the pygmies. Further studies is recommended to elucidate the medicinal and pharmaceutical benefits of plants used for tooth sensitivity and other oral health problems by the pygmies.

Parental perceptions of dental visits and access to dental care among disabled schoolchildren in Kuwait

The objective of this study was to describe dental visiting habits and access to dental care among the disabled schoolchildren in Kuwait. A total of 308 parents of children with a physical disability (n = 211), Down syndrome (n = 97) and teachers, who had normal children (n = 112) participated in the study. Less than one-fourth (21%) of the disabled children and 37% of the normal children had never visited a dentist (p = 0.003). Majority of Down syndrome (72%) and physically disabled children (59%) received curative dental care compared to 47% of normal children (p = 0.016). A bigger proportion of disabled children (42%) visited the dentist due to tooth ache than the normal ones (25%) (p < 0.01). Only 9.6% of Down syndrome children perceived no barriers to seek the dental care compared to 26.2% of physically disabled and 32.2% of normal children (p = 0.008). Difficulty to get an appointment was the most common perceived barrier to dental care by parents of Down syndrome children and the normal children (37.3%). Parents of disabled children considered difficulty in cooperation as a more important barrier to treatment (34.7%) than the parents of normal children (20.3%). Larger proportion of parents of normal children (82%) rated the present dental services as excellent/good compared to 52% of the parents of disabled children (p < 0.001). Toothache and curative treatment need were the main reasons for dental visits among disabled children. Regular dental check-ups and preventive oral health care should be encouraged for comprehensive coverage of the national school oral health program for the disabled in Kuwait.

Dentists' views on the effects of changing economic conditions on dental services provided for children and adolescents in Iceland

In 2008, Iceland experienced a major financial crisis, with serious effects on the economy of the country and its inhabitants.

OBJECTIVE

To describe the opinions of dentists in Iceland regarding the influence of economic changes on the demand for dental health services for children and adolescents, aged 0-18 years, and also to describe the preventive dental care the dentists reported providing for children and adolescents.

BASIC RESEARCH DESIGN AND PARTICIPANTS

Questionnaires were sent by electronic mail to all dentists in Iceland in January 2013. Of the dentists working with children, 161 (62%) returned the questionnaire.

RESULTS

Important findings were that 119 (74%) of the respondents reported increased caries experience in children and adolescents and 150 (93%) reported that decreased reimbursement for dental treatment of children in recent years had affected the dental health of most or some children and adolescents. Most dentists reported reduced parental demand for most aspects of caries prevention and treatment, apart from treatment for acute dental pain. The mean interval between dental visits was reported to be 9.4 months (sd 2.8) and the mean maximal interval 12.1 months (sd 2.8). The mean proportion of working time allocated for caries preventive services was reported to be 31% (sd 21).

CONCLUSIONS

The results indicate a contrast between increased need for children's dental care perceived by the dentists and reduced demand for care from the parents. This may be a temporary phenomenon, as the economic crisis passes, reimbursement for dental care may increase.

Oral health behaviours amongst homeless people attending rehabilitation services in Ireland

STATEMENT OF THE PROBLEM

Research on oral health behaviours and dental care service uptake of drug users and those in recovery remains scant.

PURPOSE OF THE STUDY

The research aimed to explore and describe perspectives of drug users on their oral health behaviours, awareness of oral health complications caused by alcohol, cigarette and drug use, dental service uptake and opinions on improved dental service for active and recovering addicts.

MATERIALS AND METHODS

Two focus groups with a purposeful sample of participants (n = 15) were conducted in two treatment and rehabilitation settings. The semi-structured guide consisted of open questioning relating to dental access and uptake, oral health, awareness of oral cancers, nutrition and substance consumption on oral health, and opinions around optimum oral health and dental service provision for active drug users and those in recovery. Thematic analysis of narratives was conducted.

RESULTS

Participants described barriers to access and uptake, poor levels of preventative dental care, DIY dentistry in the event of dental emergencies, substance use to self-medicate for dental pain, mixed awareness of the effects of sugary products and substance use on oral health and cancers, and emphasised the importance of preventative dental care and dental aesthetics when in recovery.

CONCLUSIONS

Findings illustrate a profile of oral health behaviours in Irish drug users, with information useful for private and public practice, and in the further development of street, community and treatment setting oral health interventions.

A chemical burn from a garlic poultice applied to the face to treat toothache: a case report

This case report is of a significant chemical burn to the face resulting from the use of an external garlic poultice for toothache. The patient used internet search engines to seek a toothache remedy and did not identify any reports of this complication. This report aims to inform all dentists of the risks of raw garlic application to the skin and also to ensure that in the future any patient using the internet for a toothache remedy will be made aware of the potential risk and how to avoid it.

Dental care among young adults with intellectual disability

Dental care among young adults with intellectual disability (ID) is poorly documented and largely unmet. By using population-based data from the Metropolitan Atlanta Developmental Disabilities Follow-Up Study, we assessed factors associated with at least one or two dental visits per year among young adults with and without ID. Significantly fewer young adults with ID (45%) visited a dentist at least once per year, compared with those without ID (58%). ID severity and the presence of co-occurring developmental disabilities predicted dental care use. Sociodemographics, daily functioning, societal participation, dental services, and dental health factors were examined as predictors of dental care frequency. Our findings can help focus efforts toward improving the frequency of dental care visits among young adults with ID.

The distressed patient seeking self-harm: autonomy versus beneficence

Patient autonomy may conflict with the professional's need to practice beneficently. A case is presented showing this conflict. This incompatibility between two cardinal virtues in healthcare ethics is analyzed in terms of the philosopher Immanuel Kant's dictum that individual autonomy cannot be abridged. The tension between these two ethical principles is also discussed in terms of the 2008 voter initiative in the State of Washington allowing physician-assisted suicide.

Dental Discomfort Questionnaire for young children following full mouth rehabilitation under general anaesthesia: a Follow-up report

AIM

The aim of the present study was firstly to assess the persistence of pain related behaviours of the Dental Discomfort Questionnaire (DDQ) and secondly to complete a follow-up study to assess the effect of dental treatment on pain related behaviours in preschool children.

METHODS

The 9-question DDQ instrument was used to assess dental pain related behaviours in a group of preverbal children. The test-retest analysis questionnaire was filled out twice by 44 parents on behalf of their referred child. For the follow-up study the questionnaire was filled out by 71 parents before and after all dental disease was completed.

RESULTS

A strong correlation for the test-retest was found over a 2 month period before treatment. When the behaviour items were compared independently before and after treatment it appeared that after treatment all but one behaviour (i.e. bite with molar instead of teeth) was displayed less often. Overall, after treatment all children had a lower mean DDQ score.

CONCLUSIONS

Dental treatment of children leads to reduced toothache related behaviours and subsequently to a better quality of life. The DDQ is a sensitive instrument to measure dental discomfort before and after restorative treatment if and when the follow-up period is short. The DDQ can possibly support healthcare providers, teachers and parents in their assessment of toothache in young children.

Atypical odontalgia--an update

Atypical odontalgia is a commonly misdiagnosed condition that frequently leads to unnecessary dental treatments such as extraction and endodontic therapy. These treatments often worsen the pain. Despite greater recognition and understanding of this condition, proper diagnosis and treatment remains a challenge. It is believed that atypical odontalgia is a neuropathic condition. This article updates the current understanding of the etiology and pathophysiology of atypical odontalgia, and provides appropriate diagnostic and management approaches for this condition.

[Controlled observation on combination of Shu-stream and Ying-spring acupoints for toothache]

OBJECTIVE

To compare the therapeutic effect between combination of Shu-stream and Ying-spring acupoints and routine acupoints selected by syndrome differentiation for toothache.

METHODS

Eighty-five cases were randomly divided into a combination of Shu-stream and Ying-spring acupoints group (group A, 43 cases) and a routine acupionts group (group B, 42 cases). In group A, according to the corresponding relationship between viscera-meridians and different kinds of teeth, the Shu-stream and Ying-spring acupoints at both sides of the corresponding meridians were sleeted. The group B was treated with acupuncture at Jiache (ST 6), Xiaguan (ST 7), Hegu (LI 4), erjian (LI 2), Neiting (ST 44). Yifeng (TE 17) and Fengchi (GB 20) were added for wind and fire attacking; Lidui (ST 45) and Quchi (LI 11) were added for intense stomach fire; Taixi (KI 3) and Zhaohai (KI 6) were added for deficiency fire flaming up. Electroacupuncture was applied in two groups, once every day, ten treatments constituted one course, the differences of effect and recurrence rate were observed after one course and half a year later.

RESULTS

The cured rate were respectively 88.4% (38/43)and 69.0% (29/42) in group A and group B, with a significant difference (P < 0.05). The recurrence rates were respectively 23.7% (9/38) and 55.2% (16/29) in group A and group B, with a significant difference (P < 0.05).

CONCLUSION

Both short-term and long-term therapeutic effects of combination of Shu-stream and Ying-spring acupoints are significantly better than those of routine acupoints in treating toothache.

Concordance among different pain scales in patients with dental pain

AIMS

To evaluate the concordance among different pain scales for evaluation of pain in toothache patients and to assess the influence of oral health on the quality of life of those patients.

METHODS

Ninety-two patients seeking treatment for toothache were evaluated before and after treatment. At baseline and 1 week after the dental treatment, the patients were requested to fill out the Oral Health Impact Profile Inventory (OHIP-14) as well as the following pain scales: the visual analog scale (VAS), numeric scale (NS), verbal rating scale (VRS), and Faces Pain Scale-Revised (FPS-R). The data were analyzed by Pearson correlation, Student t test, and analysis of variance for repeated measurements, with a significance level of 5%.

RESULTS

Patients were, on average, 34.4 years old. The sample was composed of 50 women and 42 men. Fifty-eight patients had dental pain of pulpal origin, and 34 had pain of periodontal origin. The mean OHIP score was 20.83 at baseline and 5.0 at 1 week after the completion of the dental treatment. The mean values of the scales at baseline were 50.7 mm, 56.7 mm, 52.2 mm, and 52.9 mm for the VAS, NS, VRS, and FPS-R, respectively. One week after the treatment, these values were 7.5 mm, 9.4 mm, 10.9 mm, and 8.7 mm. A positive correlation was detected between all four scales at baseline and also 1 week after the treatment (P < .05). At baseline, the NS was significantly different from the other scales. This difference, however, was not detected at the end of the trial.

CONCLUSION

All scales were able to detect differences in the pain reported after dental treatment and may be valid and reliable for use in clinical dental practice. The NS, however, returns higher scores at baseline when assessing the pain.

[Pain and discomfort in orthodontic treatments. Literature review]

The experience of pain and discomfort during orthodontic treatment is common. Pain is a subjective response to noxious stimuli, but it is also influenced by age, gender, previous pain experience, emotional factors and stress. The ortodontic treatments such as separation, placement of the arch wire, activation of the fix or removable appliances and debonding cause some degree of pain for the patient. In a prospective study 95% of the patients reported pain experience during orthodontic treatment. The periodontal pain caused by the combination of pressure, ischemia, inflammation and oedema. The pain starts within 4 hours, increases over the next 24 hours, and decrease within 7 days, so it may not be identified by the orthodontist at recall visit. The most common method to measure the intensity of the pain is the NRS (numerical rating scale), where patients can rate their pain intensity from 1 to 10 or 1 to 100. There are many modalities to control orthodontic pain, we can use different analgesic agents, solf-laser irradiation, transcutaneous electrical nerve stimulation and hypnotherapy. The aim of this review to provide an overview on discomfort and pain reaction during orthodontic treatments and discussion of the possible measurement and alleviation of pain.

Treatment of odontogenic pain in a correctional setting

Odontogenic pain, or toothache, is highly prevalent in correctional facilities. When there is no dental sick call because the dental clinic is closed or the facility has no dental clinic, it is critical that midlevel providers and physicians triage and manage these patients until a dentist can resolve the problem. This article explores the etiology and diagnosis of toothache, presents the authors' opinion of the standard of care for managing these patients, and makes three recommendations: (a) access to timely and definitive dental treatment should be available to all inmates experiencing dental pain, (b) antibiotic use should be limited to patients with frank infection, and (c) progress of patients awaiting a dental appointment should be monitored with frequency consistent with the differential diagnosis.

[Severe odontalgic pain preceding migraine attacks]

A 30-year-old woman appeared at the gnathology department of a centre for special dentistry complaining of migraine attacks which were preceded each time by severe odontalgic pain. Furthermore, she suffered from an autoimmune disease as well as from tension headaches. The oral health care provider in charge suspected that the episodes of odontalgic pain, which lasted for several hours or even several days, were caused by bruxism. Treatment of the bruxism resulted in reduced pain as well as reduced severity of the migraine attacks.

Maternal beliefs and motivations for first dental visit by low-income Mexican American children in California

PURPOSE

The purpose of this study was to examine Mexican American immigrant caregivers' beliefs and motivations surrounding the first dental visit for their young children (median age=5-years-old).

METHODS

Qualitative interviews were conducted among a convenience sample of 48 low-income, Mexican American mothers about their young children's oral health. Transcripts were independently read, coded, and thematically analyzed.

RESULTS

Half (51%) of first dental visits were for parent-initiated reasons, including: for pain or visible dental problems; for parent's proactive desire to get a checkup; or to avoid future dental problems. The other half was initiated by external prompts, especially pediatrician recommendations and school requirements. Once a child went to the dentist for his/her first visit, 94% continued with regular checkups. The mean age for a first dental visit was 3-years-old. Three parents reported cases in which dentists discouraged visits for symptomatic children before they were 3-years-old.

CONCLUSIONS

The low-income, urban Mexican American parents interviewed take their children to their first dental visit when they are approximately 3-years-old, much later than the recommended 1-year-old first visit for this at-risk population. Physicians are well positioned to play an important role in prompting first dental visits.

A cross-sectional survey investigating the care of the primary dentition by general dental practitioners working in Japan and England

OBJECTIVE

To compare treatment decisions about primary dentistry made by Japanese and English general dental practitioners (GDPs).

METHOD

Four clinical scenarios were used to ascertain the clinical opinions of GDPs about what treatment to offer a 6-year-old boy with a carious molar. The first and second scenarios were a single distal and a distalocclusal cavity in a vital tooth without pain. The third was a large distal-occlusal cavity in a non-vital tooth without pain. The fourth was large distal-occlusal cavity in a non-vital tooth with pain. The participants were 234 GDPs in Japan and 322 GDPs in England.

RESULTS

In the first scenario, 62.2% of Japanese GDPs preferred traditional restorative care compared with 34.7% of English GDPs. In the second scenario, Japanese participants were less likely to offer atraumatic treatment (16.5% vs. 34.9%). In the third scenario, Japanese dentists displayed a greater tendency to open the pulp chamber (55.2% vs. 7.6%). In the final scenario, 71% of Japanese GDPs would open the pulp chamber, whereas 50.3% of English GDPs favoured extraction.

CONCLUSION

Japanese and English GDPs differed substantially in their views about the best treatment for a young child with a carious molar.

[Acute conditions of the oral cavity]

Acute conditions are mainly caused by inflammatory and infectious reactions in the dental pulp, periodontal tissues, periapical bone and the tissues around partially impacted teeth. Pain may also be related to traumatic injuries to the teeth and jaws as well as sequelae after oral surgery. Emergency treatment involves incision of abscesses, root canal treatment, irrigation with antiseptics, immobilisation of teeth or fractured bones, and prescription of analgetics. Antibiotics are only indicated in cases in which there is a risk that an infection spreads to adjacent regions or a risk of fever and malaise.

Endodontic treatment completion following emergency pulpectomy

AIM

Emergency pulpectomy is frequently performed to relieve pain experienced by patients following acute episodes of endodontic pain, or to limit the risks of infection or possible root resorption following traumatic pulpal exposures. The aim of this study was to examine subsequent patient attendance for completion of root canal treatment following pulpectomy procedures in a dental emergency unit.

METHODS

The treatment records of 574 patients who had each received an emergency pulpectomy at the Casualty Clinic of the University Dental School and Hospital, Cork, Ireland were reviewed. The influence of age, gender, etiology, tooth type, and month in which the pulpectomy was performed on subsequent completion of endodontic treatment was examined.

RESULTS

Of 574 patients, 39% (n = 224) returned to have endodontic treatment completed, 11% (n = 63) returned to have the tooth extracted, and 50% (n = 287) did not return for completion of the endodontic treatment. Cases were monitored up to five years following pulpectomy. Using a multinomial regression model, tooth type, etiology, and month in which the treatment was performed were found to be statistically significant predictors (p < 0.05) of endodontic treatment completion in the Cork University Dental School and Hospital.

CONCLUSIONS

Proper patient selection and pre-treatment counseling are important considerations when planning emergency pulpectomies to avoid inappropriate use of resources and manpower.

Frequency of persistent tooth pain after root canal therapy: a systematic review and meta-analysis

INTRODUCTION

Little is known about the frequency of persistent pain after endodontic procedures even though pain is a core patient-oriented outcome. We estimated the frequency of persistent pain, regardless of etiology, after endodontic treatment.

METHODS

Persistent tooth pain was defined as pain present > or = 6 months after endodontic treatment. Endodontic procedures included in the review were pulpectomy, nonsurgical root canal treatment, surgical root canal treatment, and retreatment. Four databases were searched electronically complemented by hand searching. Two independent reviewers determined eligibility, abstracted data, and assessed study quality. A summary estimate of persistent all-cause tooth pain frequency was established by using a random-effects meta-analysis. Using subgroup analyses, we explored the influence of treatment approach (surgical/nonsurgical), longitudinal study design (prospective/retrospective), follow-up rate, follow-up duration, initial treatment versus retreatment, and quality of reporting (Strengthening the Reporting of Observational Studies in Epidemiology rankings) on the pain frequency estimate.

RESULTS

Of 770 articles retrieved and reviewed, 26 met inclusion criteria. A total of 5,777 teeth were enrolled, and 2,996 had follow-up information regarding pain status. We identified 168 teeth with pain and derived a frequency of 5.3% (95% confidence interval, 3.5%-7.2%, p < 0.001) for persistent all-cause tooth pain. High and statistically significant heterogeneity among studies (I2 = 80%) was present. In subgroup analysis, prospective studies had a higher pain frequency (7.6%) than retrospectives studies did (0.9%). Quality of study reporting was identified as the most influential reason for study heterogeneity.

CONCLUSIONS

The frequency of all-cause persistent tooth pain after endodontic procedures was estimated to be 5.3%, with higher report quality studies suggesting >7%.

Dental needs and socioeconomic status associated with utilization of dental services in the presence of dental pain: a case-control study in children

AIMS

To identify the effect of unmet dental treatment needs and socioeconomic and sociodemographic variables on the patterns of dental visits in the presence of dental pain in 6- to 12-year-old Mexican schoolchildren.

METHODS

A case-control study included 379 patients that had a dental visit because of dental pain in the 12 months preceding this study and 1,137 controls. Mothers and/or guardians supplied sociodemographic, socioeconomic, and oral health-related information through a questionnaire. The profiles of unmet dental needs and of oral hygiene were ascertained by means of a standardized dental examination administered to participating children. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated with logistic regression.

RESULTS

Higher unmet dental needs and lack of health insurance were associated with the experience of dental visits because of dental pain in the preceding 12 months. Boys who attended public schools had a 70% (95% CI = 1.29 to 2.23) higher probability of having had a dental visit in which dental pain was one of the main reasons for attendance, compared to boys attending private schools. The effect for girls was only 28% (95% CI = 1.10 to 1.50) higher for girls attending a public school, compared to girls attending private schools. Older children had a higher occurrence of dental visits because of dental pain than younger children.

CONCLUSIONS

While higher unmet dental needs and lack of health insurance were strong predictors of having had dental visits because of dental pain in the preceding 12 months, some socioeconomic variables and sociodemographic variables modified these relationships.

The Slovenian version of the Oral Health Impact Profile Questionnaire (OHIP-SVN): translation and psychometric properties

The aim of the study was to develop and to test the psychometric properties of the Slovenian version (OHIP-SVN) in the new cultural context. Construct validity was tested on 430 subjects, test-retest reliability on 60 subjects, internal consistency on 460 subjects, and responsiveness on 30 patients with a treatment demand (toothache). The significant association between the OHIP summary scores and the self-reported oral health (p < 0.001) confirmed the construct validity. The test-retest reliability showed high intraclass correlation coefficients and no significant differences between the two administrations (p > 0.05). The internal consistency showed high Cronbach's alpha (0.97). The responsiveness was confirmed by the statistically significant difference between the mean OHIP score at baseline and follow-up (p < 0.001) and by a considerable effect size in the patients with a treatment demand (0.515). The OHIP-SVN, as one of the first translation into one of the Slavic family of the languages proves that this instrument is suitable for the assessment of the Oral Health Related Quality of Life in Slovenia.

The role of non-dental health professionals in providing access to dental care for low-income and minority patients

The disadvantaged suffer disproportionately from dental problems. These persons are more likely to have untreated oral health problems and associated pain, and also are more likely to forego dental treatment even when in pain. There has been increased emphasis on the potential role of physicians in alleviating oral health disparities, especially among children. In addition, many adults lacking access to traditional dental services seek care and consultation from hospital emergency departments, physicians, and pharmacists. The delivery of oral health care services by non-dental health professionals may assume increasing importance as the population continues to age and becomes more diverse. This is because, in general, the elderly and ethnic and racial minorities face significant economic barriers to accessing private dental services.

Recognition and management of odontogenic referred pain

There are times when referred pain makes it difficult to locate the source of odontogenic pain. In those situations, additional evaluation or referral is needed to determine the cause of the chief complaint. This article presents two cases that illustrate the difficulty and frustrations of referred pain for both patients and dentists. After a thorough evaluation and diagnosis, the true sources of the patients' chief complaints were identified and treated, leading to complete resolution of their symptoms. These cases emphasize the importance of listening to the patient, obtaining a detailed dental history, collecting comprehensive diagnostic data, and developing an accurate diagnosis before initiating treatment. When a definitive diagnosis cannot be determined, referral may be necessary to provide the best treatment possible.

[The overview of the prevention and treatment of dental disease in ancient China]

About 2000 years ago, our country already had a record about mouth washing. It was one of the earliest countries that invented teeth brushing and the toothbrush. It mentioned many kinds of effective techniques of teeth protection and health improvment such as swallowing the saliva, knocking the teeth and practising Qigong. About 3000 years ago, our country already had records about dental disease and had established the specialty of stomatology and dentistry in the Tang dynasty. The methods of treating toothache by acupuncture and external medicine, treating caries by arsenic trioxide and using silver paste to fill the teeth, using artificial teeth for restoration, and treating periodontosis by teeth-cleaning techniques all took the lead in the world. Traditional Chinese Medicines are still used today to treat toothache and periodontosis in clinic.

Diagnosis dilemmas in vital pulp therapy: treatment for the toothache is changing, especially in young, immature teeth

The literature is almost devoid of scientific studies of diagnosis of pulpal pathology in primary and permanent teeth with open apices. Most reports are empirical or retrospective studies without adequate prior knowledge of preexisting conditions or histologic findings leading to the necessity of pulpal procedures. Appropriate diagnostic tests and their effectiveness are documented for both groups. This article reviews the available literature and current techniques of indirect pulp therapy, pulp capping, and pulpotomy for primary teeth and permanent teeth with open apex. The apical barrier with mineral trioxide aggregate followed by root strengthening with bonded composite is reviewed.

Atypical odontalgia: a case report

Diagnosis and treatment of orofacial pain is not uncommon; however, reaching a definitive diagnosis in these cases can be a complex challenge. Dentists are most likely to face this situation, because persistent and chronic pain is more common in the head and neck region than in any other part of the body. However, the complexities and diagnostic challenges mean that misdiagnosing neuropathic pain is common. This article presents a case of atypical odontalgia and illustrates the complexities involved when diagnosing the condition.

Septic arthritis of the temporomandibular joint in a 6-year-old child

Septic arthritis of the temporomandibular joint (TMJ) is rare, and is almost exclusively confined to adults; we know of only four cases previously described in children. We present a 6-year-old girl who had septic arthritis of the temporomandibular joint with no obvious cause. We stress the need for prompt diagnosis and intervention to prevent serious consequences.