Toothache Research Articles

Dental Emergency Rates at an Expeditionary Medical Facility Supporting Operation Inherent Resolve.

A core objective of U.S. medical services is to ensure the medical and dental readiness of military personnel. Oral diseases, resulting in pain, infection, or functional impairment, greatly affect the operational effectiveness of military personnel. This study aimed to compare the current causes of dental emergencies and the rates of dental disease nonbattle injuries in a deployed setting with those documented in previous research. Additionally, the study sought to determine if these rates have decreased because of preventive measures or potential improvements in overall oral health. Each soldier reporting to the health facility for dental care was screened by a dentist to determine the presence of a dental emergency. The reason for seeking care was classified into 1 of 7 categories and the rate of dental emergencies per 1,000 military members per calendar year was calculated. The majority of emergencies (38.60%) were due to tooth fractures and/or caries. The second most common reason for visiting the dental clinic was pain from a tooth requiring endodontic therapy (16.81%). This was followed by musculoskeletal or nonendodontic tooth pain (16.10%), most often associated with stress. Periodontal issues accounted for 14.33% of emergencies. Teeth requiring extraction made up 7.16% of all emergencies, prosthodontic bonding complications accounted for 5.16%, and orthodontic bonding complications affected 1.84% of individuals. The dental disease nonbattle injuries rates determined from the current study were 154 emergencies per 1,000 personnel per year for Air Force members and 264 emergencies per 1,000 personnel per year for Army members, which align with previous research findings. The results of this study confirm that dental emergencies continue to be a threat to overall readiness in deployed environments. The primary etiologic factor in the current study was as a result of tooth fracture and/or caries.

Analysis of Clinical Application of Minimally Invasive Technique in Alveolar Surgery

Objective To explore the clinical effect of minimally invasive techniques in the treatment of alveolar surgery. Methods 80 patients who underwent dental surgery from March 2023 to March 2024 were selected as study samples and randomly divided into two groups. The control group (40 cases) underwent the traditional extraction method, and the observation group (40 cases) underwent the minimally invasive technique. The integrity rate of tooth extraction, pain rate, postoperative infection rate and treatment effect were compared between the two groups. Results The integrity rate of tooth extraction, pain rate and postoperative infection rate in observation group were lower than those in control group (P < 0.05). The therapeutic effect of observation group was significantly higher than that of control group (P < 0.05). Conclusion Minimally invasive technique has a significant effect in the treatment of alveolar surgery, which can reduce the degree of pain and the probability of infection and improve the integrity of the alveolar.

Extent of Endoscopic Sinus Surgery for Odontogenic Sinusitis of Endodontic Origin with Ethmoid and Frontal Sinus Involvement.

Background/Objectives: Odontogenic sinusitis (ODS) is the most common cause of unilateral maxillary sinus opacification. Initial treatment consists of intranasal steroids and antimicrobial therapy. In case of persistence of the disease, endoscopic sinus surgery (ESS) is advised. It is still not clear what extension of ESS is required and whether frontal sinusotomy or ethmoidectomy is justified in ODS with frontal sinus involvement. Methods: Adult patients presented with uncomplicated recalcitrant bacterial ODS due to endodontic-related dental pathology were evaluated by an otolaryngologist and a dentist and scheduled for ESS. Sinus CT scan demonstrated opacification of maxillary sinus and partial or complete opacification of extramaxillary sinuses ipsilateral to the side of ODS. Patients were undergoing either maxillary antrostomy, antroethmoidectomy, or antroethmofrontostomy. Preoperative and postoperative evaluations were done with nasal endoscopy, dental examination, subjective and radiological symptoms. Results: The study group consisted of 30 patients. Statistically significant decreases in values after surgery were found for SNOT-22, OHIP-14, Lund-Mackay, Lund-Kennedy, and Zinreich scale. Tooth pain was present in 40% cases during the first visit and in 10% during the follow-up visit. Foul smell was initially reported by 73.3% and by one patient during follow-up visit (3.3%). Significantly longer total recovery time and more crusting was marked for antroethmofrontostomy when compared to maxillary antrostomy. Conclusions: ESS resolved ODS with ethmoid and frontal involvement in almost every case. Minimal surgery led to improved overall clinical success in the same way as antroethmofrontostomy without risking the frontal recess scarring and stenosis.

Emergency of oral haemorrhage: Retrospective study over 2 years.

Oral haemorrhages (OH) represent a relatively rare reason for an emergency consultation, among dental pain, infectious processes and traumas. Various haemorrhagic risk factors are described, particularly those related to a general medical context or local factors. It is common to associate OH with haemorrhagic risk patients. Current studies mainly focus on patients considered at risk, but there is limited data on the characteristics of OH in patients without known haemorrhagic risk. We conducted a 2-year retrospective study in a dental emergency department to identify OH occurring in patients without known haemorrhagic risk and to study their characteristics. OH accounted for approximately 2% of the reasons for consultation among all consultations carried out for dental emergencies. Their frequency was similar in the population of patients without hemorrhagic risk and those with a confirmed risk. They mainly occurred in young patients, without medical history. They also led to the diagnosis of an underlying pathology in about 1% of cases. This study underscores the importance of accurately documenting patients' medical history during preoperative consultations, as well as identifying associated risk factors. It also highlights that OH can be an early sign of a systemic disorder.

PRESCRIBING PATTERNS OF ANALGESICS FOR DENTAL PAIN IN TERTIARY CARE HOSPITALS OF KHYBER PAKHTUNKHWA (KP)

Background: Analgesics are prescribed for dental pains and inflammation. Dentists need to analyze the prescribing patterns of analgesics in Khyber Pakhtunkhwa (KP). Objectives: The study aims to assess the rational use and patterns of prescribing analgesics for dental pain and inflammation management based on information obtained from dentists in KPK. Methodology: The current investigation utilized prescriptions to study dentists’ prescribing patterns of analgesics. The data was collected during October 2022 and August 2023. The prescriptions were collected from tertiary care hospitals in KP province. Results: A total of 400 patients’ prescriptions were analyzed, comprising males (55%) and females (45%). The most frequently prescribed generic analgesics were flurbiprofen (n= 174), ibuprofen (n= 49), paracetamol (n= 19), naproxen sodium (n= 18), lornoxicam (n= 18), and nimesulide (n= 17). The most common brand prescriptions included Tornil (n= 97), Brufen (n= 48), Inflamatix (n= 44), Synflex (n= 3), and Ansaid (n= 8), and Panadol (n= 10), among others. The prescribed dosage forms for male patients were primarily tablets (92.73%), followed by syrup (0.91%) and suspension (0.45%), and for female patients were primarily tablets (98%), followed by syrup (2%), capsules (1%), and gel (1%). Among the patients, 91 drugs were prescribed from the Essential Drug List (EDL), while 304 drugs were not from the list. Conclusion: The current study’s findings showed that flurbiprofen and ibuprofen were the medications that dentists prescribed most frequently as analgesics for dental pain therapy. Many of the drugs chosen were not from the EDL.

Rising trend of dentist-prescribed antibiotics in Brazil: 2011-2021.

To describe the trends in antibiotic prescribing by dental practitioners and to investigate the relationship between these trends and some factors of public oral health services in Minas Gerais (MG), Brazil. This was a time-series analysis of antibiotics prescribed by dental practitioners between January 2011 and December 2021. The outcome variables were number of defined daily doses (DDD) and DDD/1000 population/year in a sample of cities in MG. Covariates were public oral healthcare factors, such as coverage, estimates of dental procedures, and frequency of dental pain. Linear time-series regression models were used to examine trends and the influence of covariates on antibiotic prescribing. Overall, the number of prescriptions increased by 334.69% between 2011 and 2021, with amoxicillin being the most commonly prescribed drug (78.53%). The number of DDD for all antibiotics increased from 17,147.13 to 77,346.67 and the average DDD/1000 inhabitants/year was 126.66 (SD: 130.28). The linear time-series regression model showed that for each one-year increase, the average log DDD/1000 inhabitants increased by 0.35 (standard error = 0.07, p < 0.001). No covariates were found to be associated with the outcome. In Minas Gerais, Brazil, a significant upward trend was observed in the number of prescriptions and the number of DDD of antibiotics prescribed by dental practitioners. No influence of factors related to public oral healthcare services on the outcome was observed, thereby emphasizing the need for further research on factors influencing medication use in dental practice.

Atypical Odontalgia or Phantom Tooth Pain: Current Evidences for Better Understanding, Diagnosis and Management

Atypical Odontalgia or Phantom Tooth Pain: Current Evidences for Better Understanding, Diagnosis and Management

A Rare Case Of Desmoid Tumor In The Lower Mandibular Sector Of An Adolescent: Surgical Intervention And Outcomes

Introduction: Desmoid tumors are rare, benign neoplasms known for their locally aggressive behavior and high recurrence rates. They arise from fibroblasts and are characterized by their infiltrative growth, making surgical management challenging. This report presents a case of a desmoid tumor in the lower mandibular sector of a 16-year-old male, focusing on surgical intervention and molecular insights. Case Report: A 16-year-old male presented with a growing mass in the lower right mandible, causing pain and mobility of tooth 47. Imaging revealed an infiltrative lesion eroding the mandibular bone. Histopathological analysis confirmed a desmoid tumor with spindle-shaped fibroblasts and nuclear β-caténine expression. Molecular testing identified a CTNNB1 gene mutation, confirming the diagnosis. Discussion: Desmoid tumors, despite being benign, are challenging due to their aggressive local behavior. Surgical excision with clear margins is the primary treatment, as these tumors are resistant to chemotherapy and radiotherapy. This case highlights the importance of precise surgical planning and the role of β-caténine and CTNNB1 mutations in diagnosis and prognosis. Conclusion: Effective management of desmoid tumors in adolescents requires thorough surgical intervention and comprehensive diagnostic analysis. Long-term follow-up is crucial to monitor for recurrence. The molecular characteristics of the tumor, such as CTNNB1 mutations, play a significant role in guiding treatment and predicting outcomes.

87 The Impact of Dental Blocks on Emergency Department Revisits: A National Study of Emergency Department Patients With Dental Pain

87 The Impact of Dental Blocks on Emergency Department Revisits: A National Study of Emergency Department Patients With Dental Pain

Supercritical carbon dioxide as solvent for manufacturing of ibuprofen loaded gelatine sponges with enhanced performance

Supercritical carbon dioxide was used as the solvent for manufacturing of ibuprofen loaded gelatine sponges with high loading capacity and fast release performance toward healthcare materials in the treatment of postoperative dental pain. The solubility of ibuprofen in supercritical CO2 was first determined at 313 K under different pressure conditions. The micronisation of ibuprofen drugs were successfully adsorbed onto the surface of network pore system of gelatine sponges via supercritical CO₂ processing. The loading capacity of ibuprofen in gelatine sponges obtained by using supercritical CO₂ as the solvent can be up to 19.86 wt%, which was double that of the sample prepared by direct soaking in ethanol. The dissolution of ibuprofen was determined and higher instantaneous dissolution rate was observed for the ibuprofen loaded gelatine sponges synthesized by supercritical CO₂ processing.

Patients’ reasons for consulting a general practitioner at the time of having dental problems: a qualitative study

IntroductionMany patients consult general practitioners instead of dentists for their oral and dental problems every year. This study aims to find the reasons why patients consult general practitioners when they have dental problems.MethodsThe sample consisted of patients visiting dentists and general practitioners in Kerman, Iran. A thematic interview guide, semi-structured questions, and a mind map that allowed for structured and open-ended questions were prepared and used for the interviews. All interviews were recorded and transcribed verbatim by a final-year student. Data collection, transcription, and analysis were conducted simultaneously to allow for new topics to be raised and theoretical saturation to be reached. When researchers determined that sufficient information was available for analysis and understanding of patient opinions and beliefs, the interview process was stopped. As all audio conversations were recorded with the participant’s permission, no note-taking was done during the interviews, which allowed for greater focus on the participants’ conversation. The obtained data was analyzed using the content analysis.ResultsA total of 52 patients were included in this study. The codes related to patients participating in this research, along with the number of respondent groups related to each code were as follows: patient’s perceptions of general practitioner(GP) and dental practitioner’s scope of work [21], flawed dental system (34), dental anxiety [28], financial considerations [25], and more accessibility to GPs (31). Dental abscesses and dental pain were reported as the most common reasons for consulting GPs.ConclusionMost participants agreed that dental problems are more effectively treated by dentists. Reasons for visiting a general practitioner included lack of a specific dentist, dissatisfaction with dental treatments, lack of a dentist nearby, absence of emergency dental care, and familiarity with a physician. The most common reasons for visits were toothache and dental abscesses. Patients also sought treatment for TMJ pain, referred nerve pain, wisdom tooth pain, numbness and tingling in the jaw, gum inflammation, oral lesions, and ulcers. Furthermore, other factors such as opening hours, appointment systems and waiting time can also affect patient’s consult behaviors regarding dental problems.

Childhood Socioeconomic Status Affects Dental Pain in Later Life.

Lower socioeconomic status (SES) is associated with increased dental pain among children. Lower SES in childhood may also contribute to the experience of dental pain among older adults, regardless of the SES in later life. However, this association is still unclear. We used cross-sectional data from the 2019 Japan Gerontological Evaluation Study using self-administrated questionnaires to investigate the causal mediating pathways between childhood SES and dental pain in later life using several SES variables collected at older age as potential mediators. A total of 21,212 physically and cognitively independent participants aged 65 y or older were included in the analysis. The dependent variable was experiencing dental pain during the past 6 mo. The independent variable was the SES at the age of 15 y (low/middle/high). Ten covariates were selected covering demographics and other domains. Education, subjective current income, objective current income, objective current property ownership, and the number of remaining teeth were used as mediators. Prevalence ratios (PRs) and 95% confidence intervals (95% CIs) for dental pain by childhood SES were calculated using a modified Poisson regression model. The mean age of the study participants was 74.5 ± 6.2 y, and 47.5% were men. Of these, 6,222 participants (29.3%) experienced dental pain during the past 6 mo, and 8,537 participants (40.2%) were of low childhood SES. Adjusted for covariates and mediators, the participants with middle and high childhood SES had a lower PR of dental pain (PR = 0.93 [95%, CI 0.89-0.98], PR = 0.79 [95% CI, 0.73-0.85], respectively). Almost 40% of the association between childhood SES and dental pain at older age was mediated via SES in later life and the number of teeth. This study reemphasizes the importance of support for early-life SES to maintain favorable oral health outcomes at an older age. The results of this study can be used by policymakers to promote policies based on a life-course approach that supports children living in communities with low SES and helps them maintain favorable oral health outcomes into their older age.

Nonodontogenic Causes of Toothache: A Case Series and Narrative Review

Abstract Chronic orofacial pain is a complex and frequently misdiagnosed condition that significantly impacts individuals’ well-being. Accurately diagnosing orofacial pain can be challenging due to the overlap between headaches and orofacial regions. Patients who complain of tooth pain may actually be experiencing pain unrelated to dental issues. It is crucial for clinicians to accurately pinpoint the source and location of the pain to devise effective treatment plans. Nonodontogenic facial pain can stem from various causes such as musculoskeletal, neuropathic, or neurovascular issues. In addition, toothaches can result from conditions originating from other areas like systemic disorders related to the heart, nose, throat, or sinuses. Referred pain phenomena are acknowledged in the literature but are poorly understood, presenting significant treatment challenges. This is worrisome because such patients are more prone to developing chronic pain conditions, and invasive treatments may exacerbate their suffering and overall health. In the current review paper, three cases are detailed: one of myofascial pain, the second of trigeminal neuralgia, and the third of posttraumatic trigeminal neuropathy. In all three cases, dentists were the initial point of consultation as the pain was perceived in the teeth, resulting in unnecessary dental interventions. There remains a lack of knowledge regarding nonodontogenic toothache among clinicians. Increasing awareness of nonodontogenic toothache can help avoid unnecessary interventions and improve overall pain relief for patients.

Oral and Dental Pain Management

Pain has been defined as an unpleasant sensory and emotional experience associated with or resembling that associated with actual or potential tissue damage. Pets often experience the same pain as people; however, dental pain is often overlooked, discounted, or unseen/hidden in patients, as the inability to communicate does not negate the possibility that a human or a nonhuman animal experiences pain. This article discusses types of pain and the methods and medications available to treat and prevent oral pain.

Role of Salivary Protease Enzymatic Activity in Saliva of Children with and without Early Childhood Caries: A Randomized Clinical Trial.

Early childhood caries (ECC) is one of the most prevalent diseases in children worldwide. Early childhood caries is driven by a dysbiotic state of oral microorganisms, mainly caused by a sugar-rich diet. Additionally, poor oral hygiene or insufficient dental plaque removal leads to the rapid progression of ECC. Early childhood caries leads not only to dental destruction and pain in children but also affects the quality of life of the caregivers.Additionally, upon neutrophil activation at inflammatory locations, these proteases are externalized in an active state, aiding in the control of inflammatory and immunological responses. Any enzyme that catalyzes proteolysis reactions is known as a protease. Proteases are produced by human glands or derived from microbes in the oral cavity. Additionally, the oropharyngeal mucosae and crevicular fluids are sources of protease. This study is aimed at the estimation and correlation of salivary protease enzymatic activity in the saliva of children with and without ECC. A total of 50 children were included in the study, which was divided into two groups: group I (caries-active) and group II (caries-free)-each consisting of 25 children. Unstimulated saliva samples were collected and subjected to a spectrophotometer for analysis. Salivary protease levels were estimated and correlated between caries-active and caries-free children. The correlation between caries score and salivary protease activity was statistically significant with a moderate correlation. The comparison of mean salivary protease activity between caries-active and caries-free groups was statistically significant. However, the comparison of salivary protease activity based on different age-groups was not statistically significant, whereas gender and caries scores in group A were statistically significant. In conclusion, there is a substantial correlation between salivary protease enzyme levels and the severity of dental caries, and an increase in salivary protease enzyme levels is linked to a considerable rise in caries severity. As a result, prevention may be possible with early detection. Thimmegowda U, Kuri PN, Dhamnekar P. Role of Salivary Protease Enzymatic Activity in Saliva of Children with and without Early Childhood Caries: A Randomized Clinical Trial. Int J Clin Pediatr Dent 2024;17(8):877-880.

A Rare Case of Subclinical Hypophosphatasia In An Adult Patient

Background: Hypophosphatasia (HPP) is a rare genetic condition caused by a mutation in the ALPL gene. It is often misdiagnosed due to its wide range of clinical presentations and late onset of symptoms. Case Presentation: We present a case of a 48-year-old male with seemingly subclinical hypophosphatasia who initially presented with slight tooth pain. Upon further examination, chronic low alkaline phosphatase levels were identified, leading to genetic testing that confirmed HPP. The patient's elevated vitamin B6 levels and the identification of a heterozygous exon 2 deletion mutation in the ALPL gene were key diagnostic findings. Conclusion: This case highlights the spectrum of symptoms that patients with HPP can present and emphasizes the importance of considering HPP as a differential diagnosis for patients with low alkaline phosphatase levels. Recognizing this condition is crucial, as standard treatments for hypocalcemia, such as bisphosphonates, are contraindicated in HPP patients. Continued research and publication of mild and subclinical forms of HPP are vital to improve the understanding and management of this disease.

Róża (Rosa L.) w polskim ziołolecznictwie ludowym od drugiej połowy XIX do początków XXI wieku

The rose is a versatile plant, it provides “jam and wine”, surrounds us with beauty and a pleasant scent, which in the form of essential oil is also a valuable cosmetic. The flowers, fruits, leaves, roots and galls, and even the soil in which it grew, were used in traditional herbal medicine in rural communities. These raw materials were used to prepare infusions, decoctions, jams, juices, water and alcohol extracts, ointments and smoke, which were used to fumigate the sick person or diseased places. They were used to treat eye diseases, dermatological diseases, diarrhea, dysentery, consumption, fever, cough, ulcers, wounds, bone, tooth, head and eye pain, and even to treat madness. Most often, however, rose was used to treat erysipelas, in Polish the name of the disease and the plant was identical, according to the principle “like cures like”. The multitude of obtained “medicines” and the variety of ways of preparing and using these raw materials indicate the ability of traditional communities to observe, draw conclusions, and also cope with situations when access to medical care was very limited. These observations, often supported by long practice, can inspire us to conduct further research on the medicinal properties of this valuable plant.

‘Tooth pain' searches have increased 500% since 2010

‘Tooth pain' searches have increased 500% since 2010

Association between parental factors and child's behaviors during moderate sedation in pediatric dental care.

Managing young children with negative behaviors can be challenging in dental settings. Moderate sedation (MS) is often used as a treatment option for such children. However, children's behavior during MS may vary depending on several variables. These variables include parental factors, such as parental anxiety, coping strategies, and pain catastrophizing. However, this area, particularly in Saudi Arabia, remains underexplored. Therefore, this study aimed to assess the association among parental anxiety, coping style, pain catastrophizing, and children's behavior during MS among Saudi children. Based on sample size calculation, this cross-sectional observational study included 85 children aged 3-5 years undergoing dental treatment under MS at King Saud University, Riyadh, Saudi Arabia. Parental anxiety, coping styles, and pain catastrophizing were assessed using the Modified Dental Anxiety Scale, Brief Coping Orientation to Problems Experienced Scale, and Pain Catastrophizing Scale. Child behavior was evaluated using the Houpt scale during sedation visits, which was video-recorded and independently analyzed by a single evaluator. Data were analyzed using Pearson's chi-squared test, Mann-Whitney U test, and stepwise multivariate logistic regression analyses. The results showed no significant association among parental dental anxiety, pain catastrophizing, and child behaviors during MS. Specific parental coping strategies, such as acceptance, were positively associated with positive sedation outcomes (P = 0.03), while active coping strategies were linked to less favorable outcomes (P = 0.03). Female children had higher sedation failure rates (P = 0.02), and the number of dental treatments was positively associated with success rates (P = 0.03). Parental anxiety and pain catastrophizing did not significantly affect the success of sedation. However, acceptance as a coping strategy was significantly associated with sedation success in pediatric dental care under MS, whereas active coping strategies were associated with less favorable outcomes.

Paracetamol Dosing Errors in People Aged 12 Years and Over: An Analysis of Over 14,000 Cases Reported to an Australian Poisons Information Centre.

Paracetamol dosing errors can cause acute liver injury, with potentially toxic doses only slightly above the therapeutic range. This study aimed to characterise unintentional paracetamol overdose reported to an Australian poisons centre, including time trends, demographics, types of dosing errors, and outcomes. Records regarding paracetamol dosing errors for individuals aged ≥12 years were extracted from the New South Wales Poisons Information Centre database, January 2017 to June 2023. Data from 2021 underwent an in-depth screening of free text case notes to examine: dose, duration, products involved, reasons for ingestion and outcomes including hospitalisation, treatment, liver transplantations and deaths. Where possible, complete outcome data were obtained from medical records of New South Wales hospitalised cases in 2021. There were 14,380 exposures due to paracetamol dosing errors (predominantly self-administered, median age 43 years, 62.6% female), with an average yearly increase of 2.5% (95% CI 1.6-3.8%; p < 0.0001). The in-depth analysis of exposures recorded during 2021 revealed 1899 exposures (median age 46 years, 63.4% female) with 26.8% requiring hospitalisation. Immediate- and modified-release formulations were highly implicated. Multiple paracetamol-containing products were ingested in approximately 20% of exposures. Hospitalised exposures were associated with paracetamol use for dental pain and ingested higher doses for longer durations. Over half of those hospitalised (52%) were treated with the antidote (N-acetylcysteine), and 6% of exposures developed hepatotoxicity. Paracetamol dosing errors continue to occur, with relatively high rates of hospitalisation and liver injury. Many hospitalisations involved use for dental pain. Possible preventative measures include ingredient name prominence and increased education on appropriate dosing.