Odontogenic Pain Research Articles

Diagnostic Challenges and Management of Non-Odontogenic Toothache: A Case of Unilateral Pansinusitis Mimicking Dental Pain

This case report details the diagnostic challenge and subsequent management of a 38-year-old male patient who presented with severe, sharp, and non-localized pain in the right maxillary distal area. Initial¬ly unresponsive to non-steroidal anti-inflammatory drugs and antibiotics, the patient’s symptoms deviat¬ed from typical odontogenic pain characteristics. Comprehensive dental examinations revealed minimal pathologies, challenging initial assumptions of dental-origin pain. Advanced diagnostic imaging, including Orthopantomography and Cone Beam Computed Tomography (CBCT), was pivotal in identifying unilat¬eral pansinusitis, with notable obstruction in the maxillary, ethmoid, and frontal sinuses. Further microbi¬ological analysis confirmed a Staphylococcus aureus and anaerobic infection, refocusing the diagnosis to a non-odontogenic source. The patient underwent a targeted 14-day complex antibiotic regimen, supple¬mented with local treatments including Nasonex nasal spray and saline nasal irrigations. This integrative approach resulted in marked symptom improvement and was instrumental in the patient’s recovery. This case highlights the critical need for thorough evaluation in distinguishing between odontogenic and non-od¬ontogenic sources of orofacial pain, ensuring accurate diagnosis and effective treatment.

PAINe: An Artificial Intelligence–based Virtual Assistant to Aid in the Differentiation of Pain of Odontogenic versus Temporomandibular Origin

IntroductionPain associated with temporomandibular dysfunction (TMD) is often confused with odontogenic pain, which is a challenge in endodontic diagnosis. Validated screening questionnaires can aid in the identification and differentiation of the source of pain. Therefore, this study aimed to develop a virtual assistant based on artificial intelligence using natural language processing techniques to automate the initial screening of patients with tooth pain. MethodsThe PAINe chatbot was developed in Python (Python Software Foundation, Beaverton, OR) language using the PyCharm (JetBrains, Prague, Czech Republic) environment and the openai library to integrate the ChatGPT 4 API (OpenAI, San Francisco, CA) and the Streamlit library (Snowflake Inc, San Francisco, CA) for interface construction. The validated TMD Pain Screener questionnaire and 1 question regarding the current pain intensity were integrated into the chatbot to perform the differential diagnosis of TMD in patients with tooth pain. The accuracy of the responses was evaluated in 50 random scenarios to compare the chatbot with the validated questionnaire. The kappa coefficient was calculated to assess the agreement level between the chatbot responses and the validated questionnaire. ResultsThe chatbot achieved an accuracy rate of 86% and a substantial level of agreement (κ = 0.70). Most responses were clear and provided adequate information about the diagnosis. ConclusionsThe implementation of a virtual assistant using natural language processing based on large language models for initial differential diagnosis screening of patients with tooth pain demonstrated substantial agreement between validated questionnaires and the chatbot. This approach emerges as a practical and efficient option for screening these patients.

Clinical Survey for Ludwig’s Angina Cases Presented in the Emergency Department of Al-Salam Teaching Hospital

Aim of the Study: To record the demographic incidence, as well as evaluate the patients that presented within a 1-year period at the Al-Salam Teaching Hospital in Mosul City, and identify the reasons, complications, duration of hospital stay, treatment outcome and management protocols utilized for such instances. Material and Method: Retrospective data collection for 68 patients presented to Al-Salam Teaching Hospital in Mosul City complaining from Ludwig’s Angina swelling. Demographic informations with clinical parameters are recorded including (age, gender, cause, referral place, duration of symptom, hospital stay, sign and symptom and type of treatment performed. Results: Show that female affected more than male, with age group between (41 – 50 years old). Dental infection s are the most common cause with odontogenic pain and swelling are highest symptoms recorded. Patients stay in the hospital 1 – 2 days and discharged with improvement. Best treatment are drainage and remove the cause & Antibiotics. No mortality rate recorded. Conclusion: Early identification, careful attention to airway maintenance, intensive intravenous antibiotic therapy, and prudent management can reduce the risk of Ludwig's angina, which is a potentially fatal consequence. Furthermore, it is critical to identify and, if possible, eradicate the infection's source with the surgical intervention. Careful attention should be performed to geriatric and children to perform good oral hygiene with periodic dental follow-up to avoid such serious complications.

Incidence, diagnosis, and management of orofacial pain among new patients receiving tertiary care in Thailand: A 6-year retrospective study comparing before and during the COVID-19 outbreak.

There is insufficient data on orofacial pain related to the COVID-19 outbreak in Thailand. To investigate the incidence, diagnosis and management of orofacial pain among new patients over the last 6 years, before and during the COVID-19 outbreak. Medical records from new patients who first visited Chulalongkorn Dental Hospital between 2017 and 2022 were retrospectively investigated. The sample size was determined, and proportional stratified random sampling was employed to distribute the sample number proportionally across each year. The hospital number of each patient was randomised using online software as a sampling strategy. A data collection form was developed and used to gather information from the digital data system. At the first visit, 770 out of 1359 patients (56.7/100 people, 95% CI: 54.0-59.3) reported orofacial pain defined as acute, chronic and unclassified pain. The most common chief complaints based on the AAOP classification were odontogenic pain (90.00%) and temporomandibular disorders (6.10%). The top three provisional modified ICD-10-TM diagnoses among these patients were pulp diseases (21.95%), impacted teeth (20.65%) and dental caries (9.09%). 81.87% of dental students' provisional diagnoses matched the final diagnoses given by dental specialists. Only 63.38% of orofacial pain patients were completely managed during the COVID-19 pandemic with common procedures being surgical removal, extraction and root canal therapy. Half of Thai dental patients seeking tertiary care at a university dental hospital reported orofacial pain, which was not impacted by the COVID-19 pandemic. In contrast, dysfunction-related problems in the orofacial area significantly increased during the pandemic.

Analgesic advice for children with special needs who have odontogenic pain

Many children struggle or refuse to take oral medications. The refusal of medication occurs for many reasons including learned and pre-existing anxiety, sensitivity to tastes and textures and sensory–motor/coordination difficulties (for tablet swallowing). Oral analgesics play a vital role in managing the odontogenic pain of children. This is especially true when they have limited access to appropriate dental care services, are pre-cooperative or lack the ability to be compliant for conventional dental treatment. CPD/Clinical Relevance: Practical advice around the facilitation of analgesic administration for odontogenic pain is lacking for parents of children who may not accept conventional preparations.

Referred pain is associated with greater odontogenic spontaneous pain and a heightened pain sensitivity in patients with symptomatic irreversible pulpitis.

Symptomatic irreversible pulpitis often results in heightened reactions to thermal stimuli such as pain evoked by a cold stimulus, and spontaneous odontogenic pain (unprovoked pain). This study primarily compared the clinical manifestations of odontogenic spontaneous pain and pain provoked by cold stimulus specifically focusing on their sensory discriminative characteristics (intensity, duration and quality) between symptomatic irreversible pulpitis patients with and without referred pain. Twenty-three patients with symptomatic irreversible pulpitis with referred pain and 12 patients without referred pain were included in this cross-sectional study. The following outcomes were assessed: odontogenic spontaneous pain and its descriptors; pain evoked by cold stimulus and qualitative sensory testing before and after local anaesthesia; referred pain location; use of analgesic medication; complementary anaesthesia efficacy. T-test, chi-squared and McNemar tests were applied to the data (p < .50). Patients with referred pain presented a greater odontogenic pain intensity (p < .05) when considered the average of the last 24 h. These patients also showed higher pain rating and pain descriptors (p < .05). Intensity and duration of the pain evoked by cold stimulus in the non-affected contralateral tooth at baseline were higher for patients with referred pain (p < .05). Symptomatic irreversible pulpitis patients with referred pain present greater odontogenic spontaneous pain and a heightened pain sensitivity. Therefore, patients with referred pain seem more complex from a pain severity perspective, supporting the clinical utility of discriminating symptomatic irreversible pulpitis with and without referred pain.

Evaluating Knowledge, Self-Reported Confidence Levels, and Prescription Patterns among Dental Practitioners Regarding Analgesics in Dentistry: A Cross-Sectional Study.

Background and Objectives: Dental pain is a common problem that often leads to unscheduled dental visits and requires a comprehensive understanding of analgesics, including their indications and contraindications. The aim of this study was to investigate dentists' knowledge, self-reported confidence levels, and prescribing patterns of analgesics in dentistry. Materials and Methods: A nationwide cross-sectional online survey was conducted, resulting in 379 responses. Of these, 68.6% were general dentists, and 31.4% were specialists. The collected data included sociodemographic information, levels of knowledge, and prescription patterns. The survey questionnaire explored self-perceived practices, patient information during prescription, and guiding factors. Descriptive statistics and a generalized linear model for regression were used for data analysis. Results: Higher levels of knowledge were observed in specific contexts such as secondary/tertiary healthcare (p = 0.022), specialization in endodontics (p = 0.003), and a higher number of working hours with patients (p = 0.038). Conversely, increased self-confidence was observed among endodontists (p = 0.008), oral surgeons (p = 0.011), and dentists with more than 6 h of patient interaction (p ≤ 0.001). Orthodontists and prosthodontists demonstrated lower knowledge levels, while specialists in family dentistry exhibited lower self-confidence. Self-confidence and knowledge displayed a significant positive correlation (r = 0.039, p < 0.001). The most frequently prescribed medication was ibuprofen (97.9%), primarily for surgical (83.9%) and endodontic procedures (60.9%), with the main indications being pulpal (85.8%), periradicular (57.3%), and postoperative pain (40.1%). Conclusions: This study reveals significant knowledge and confidence gaps among dentists, including limited awareness of the efficacy of nonsteroidal anti-inflammatory drugs for odontogenic pain, a lack of time for effective counseling, and perceived deficits in pharmacology education. To address these issues, targeted educational interventions are recommended to improve analgesic prescribing practice, close knowledge gaps, and increase dentists' confidence in more effective pain management.

Assessment of Preferences in Taking Painkillers among Students of Medicine, Dentistry, and Pharmacy: A Pilot Study.

Students of pharmacy, medicine, and dentistry are important for shaping drug policy. The aim of this study is to assess and compare students preferences in taking painkillers. The study group consists of 382 students of pharmacy (28.8%), medicine (40.0%), and dentistry (30.1%). An anonymous questionnaire consisting of 17 questions was prepared using the Google Forms platform and distributed through social media. Ibuprofen was the most frequently preferred, regardless of the study major (57.8%). Pharmacy students expressed the least concern about the possible side effects of analgesics (17.5%). The fast onset of painkillers was more important for dental students (59.1%) and pharmacy students (44.7%), compared to medical students (39.22%). Medicine and pharmacy students indicated their studies to be their main source of information about painkillers compared to dentistry students (p = 0.001). There are no differences in pain severity regarding which analgesics are used among student groups (p = 0.547). Dental students experienced odontogenic pain less frequently (57.3%) than medical (79.7%) and pharmacy students (79.8%), (p = 0.000). Ketoprofen was the most frequently chosen prescription painkiller for odontogenic pain in all groups (49.4%). Gastrointestinal complaints were the most often reported side effects, regardless of the study major (87.1%). Choice of studies, gender, and year of study were the most important determinants of the choice of painkillers.

Diagnostic Dilemma in Differentiating Odontogenic Pain and Non Odontogenic Pain: A Case Series

Pain is one of the most common reasons why patients seek medical attention. When experiencing discomfort in the orofacial region, a dentist is usually the first medical professional consulted. While odontogenic factors are the most common causes of acute pain in the maxillofacial region, it can also be non odontogenic, making it challenging to differentiate between the two. However, with a thorough examination, taking a complete history, and ordering necessary diagnostic tests, a dentist can make an accurate diagnosis and evaluate the entire stomatognathic system and other relevant anatomical regions. Misdiagnosis can lead to unnecessary dental procedures and cause trauma to the patients. Case 1 (50-year-old female) and case 3 (63-year-old female) were finally diagnosed as Trigeminal Neuralgia (TN), which were initially misdiagnosed as odontogenic pain and were treated with unnecessary irreversible dental treatments like Randomised Controlled Clinical Trials (RCT). Case 2 ( 28-year-old female) was eventually diagnosed as a case of myofascial pain with loss of muscle tone, for which the patient required palliative physical therapy. Instead, the splint, which was worn day and night by the patient, and soft diet resulted in muscle atrophy. The present case series emphasises the importance of accurate diagnosis to prevent irreversible dental treatment and protect patients from harm.

Cannabidiol as an Alternative Analgesic for Acute Dental Pain

Odontogenic pain can be debilitating, and nonopioid analgesic options are limited. This randomized placebo-controlled clinical trial aimed to assess the effectiveness and safety of cannabidiol (CBD) as an analgesic for patients with emergency acute dental pain. Sixty-one patients with moderate to severe toothache were randomized into 3 groups: CBD10 (CBD 10 mg/kg), CBD20 (CBD 20 mg/kg), and placebo. We administered a single dose of respective oral solution and monitored the subjects for 3 h. The primary outcome measure was the numerical pain differences using a visual analog scale (VAS) from baseline within and among the groups. Secondary outcome measures included ordinal pain intensity differences, the onset of significant pain relief, maximum pain relief, changes in bite force within and among the groups, psychoactive effects, mood changes, and other adverse events. Both CBD groups resulted in significant VAS pain reduction compared to their baseline and the placebo group, with a maximum median VAS pain reduction of 73–77% from baseline pain at the 180-min time point (P < 0.05). CBD20 experienced a faster onset of significant pain relief than CBD10 (15 versus 30 min after drug administration), and both groups reached maximum pain relief at 180-min. Number needed to treat was 3.1 for CBD10 and 2.4 for CBD20. Intragroup comparisons showed a significant increase in bite forces in both CBD groups (P < 0.05) but not in the placebo group (P > 0.05). CBD20 resulted in a significant difference in mean percent bite force change in the 90- and 180-min time points compared to the placebo group (P < 0.05). Compared to placebo, sedation, diarrhea, and abdominal pain were significantly associated with the CBD groups (P < 0.05). There were no other significant psychoactive or mood change effects. This randomized trial provides the first clinical evidence that oral CBD can be an effective and safe analgesic for dental pain.

Serum 3-Hydroxybutyrate is Expected to Serve as One of the Supportive Diagnostic Markers of Persistent Idiopathic Dentoalveolar Pain (PDAP).

Persistent idiopathic dentoalveolar pain (PDAP), previously referred to as atypical odontalgia, is a chronic dental pain that occurs without signs of pathology. PDAP is considered a diagnosis of exclusion, and its definition is currently under refinement and remains ambiguous. The metabolite known as 3-hydroxybutyrate (3HB) has garnered significant interest as a potential indicator for both depression and chronic psychogenic pain. We investigated the characteristics of patients with PDAP and hypothesized that serum 3HB could support the diagnosis of PDAP. Forty-one patients with PDAP and 167 patients with odontogenic toothache were investigated regarding depression and anxiety scales in addition to the general dental evaluation. Blood tests including high-sensitivity CRP, HbA1c, and 3HB were performed for all patients. Associations between PDAP and patients' varying characteristics were investigated using hierarchical multivariate logistic regression analyses. There were more females, current smokers, patients with orofacial pain (such as temporomandibular joint pain, glossalgia, and headache), and people with elevated 3HB levels among patients with PDAP than among control participants. Multivariate logistic regression analyses predicting patients with PDAP identified the female sex (odds ratio [OR]: 4.16), current smoking (OR: 14.9), glossalgia (OR: 19.8) a high CES-D score (≥16) (OR: 5.98), and elevated serum 3HB (≥80 μmol/L) (OR: 18.4) factors significantly associated with PDAP. Our results demonstrated that serum 3HB levels could be elevated in patients with PDAP compared to other types of odontogenic pain, although 3HB was not specific to PDAP. Based on our findings, five factors - female sex, current smoking, depressive tendencies, chronic orofacial pains, and high serum 3HB levels - could be useful for diagnosing PDAP.

Claves para el diagnóstico diferencial del dolor odontogénico mediante un soporte audiovisual: metodologías alternativas de aprendizaje

BackgroundDentists play a fundamental role in the diagnosis and treatment of orofacial pain, especially in pain of pulp or periodontal (odontogenic) origin. In the case of pain usually classified as chronic (non-odontogenic), a high percentage of dental students feel “not at all” or “somewhat” prepared to carry out a diagnosis and treatment. ObjectiveTo propose a brief guide to clinically differentiate odontogenic pain from orofacial pain, which is clinically useful for both dental students and professionals. Material and methodAn educational video was developed to support teaching within a teaching innovation project at the University of Valencia entitled “Orofacial Pain for Dentistry Degree Students: Acute Pain Versus Chronic Pain” (UV-SFPIE_PID-1640062. Reference No.: 64155). Eleven fundamental characteristics of odontogenic pain and another 11 of non-odontogenic pain were established, which are intended to serve as guidelines for the diagnosis in situations in which the pain does not present the usual characteristics. ResultsThe video was well accepted among students and it was understood to be an attractive learning tool that enhances motivation and the acquisition of responsibilities. 75.3% considered it to be “very interesting”, giving it the highest score. ConclusionAccording to the data currently available in the scientific literature regarding the characteristics of atypical facial pain, we believe that the guidelines provided in this project may be useful in the diagnosis of these processes.

Effective Dose of Nano Propolis as Anti-Pain in Animal Models of Mus Musculus Using Writhing Test Method

Background: Odontogenic pain has a high prevalence where this pain is the result of noxious physical stimuli or calming inflammatory mediators that stimulate receptors located at the terminal ends of nociceptive C and Aδ afferent nerve fibers. Nano propolis is an alternative material that is used as a medicine in dentistry. Nano propolis is a mixture of natural resins containing flavonoids and phenolic acids which play a role in suppressing pain response through COX and NF-kB inhibition mechanisms. Nanoparticle technology is capable of preparing active drug ingredients in nano-sized particles and can affect drug effectiveness, because particle size affects the process of solubility, absorption and distribution of drugs. Research on the potential of nano propolis as an anti-pain is still minimal, so further research is needed on the function of nano propolis as an alternative anti-pain agent. Purpose: To determine the effective dose of nano propolis on pain response in Mus musculus. Methods: This research was conducted using the writhing test method to see the analgesic effect of nano propolis. The research sample consisted of 28 Mus musculus which were divided into four treatment groups, namely the piroxicam control group, and the nano propolis treatment group of 17.5 mg/kg, 35 mg/kg, and 70 mg/kg. Results: The results showed that the four treatment groups did not have a significant difference, in other words, they had the same anti-pain effect. Conclusion: Nano propolis 35 mg/kgBB is an effective dose in suppressing pain response in Mus musculus.

Knowledge and experience of dentists with patients with trigeminal neuralgia: A prospective, cross-sectional survey study

ABSTRACT Objective Trigeminal neuralgia (TN) and orofacial pain (OFP) patients frequently refer to dentists. It is often confused with odontogenic pain and dental procedures are performed. In this study, the authors aimed to reveal the knowledge and experience of dentists about TN. Methods This is a cross-sectional study that includes dentists who participate in volunteering via an online questionnaire. The questionnaire form contains demographic data, TN treatment, and diagnosis consisting of 18 questions. Results The data of 229 dentists were examined. Almost 82% of the participants reportedly knew the diagnostic criteria of TN and 61.6% reported that they had previously referred patients with TN. The most frequently confused diagnosis was odontogenic pains (45.9%). Conclusion TN diagnostic criteria should be included more often in the education of dentists. Thus, it is possible to prevent unnecessary dental procedures. There is a need to increase knowledge on this subject with further studies involving dental students.

Use of Antibiotics in Pregnant Women for the Treatment of Dental Infections: A Short Review

Odontogenic pain is very common among pregnant women. Pregnant patients and their fetuses are more at risk when they experience pain, which frequently comes along with periapical or pulp infections. Therefore, it is crucial to offer adequate pain relief and eradication of the infection for the pregnant woman while maintaining the safety of fetus inside the womb. Antibiotics are used in endodontic treatment; thus, the choice of appropriate and safe antibiotic for pregnant patients is very important. The current study will highlight the antibiotics that can be used in the treatment of dental-related infections during pregnancy.

Effective dose of propolis extract against pain response in mice (Mus musculus) using writhing test method

Background: Odontogenic pain has a high prevalence. One of the alternative materials used as medicine in dentistry is propolis. Propolis is a mixture of natural resins containing flavonoid and phenolic acids that play a role in suppressing the pain response through COX and NF-kB inhibition mechanisms. The content of active propolis compounds is influenced by the type of bee, region, geographical conditions, climate change, seasons, and botanical sources causing different effectiveness of propolis. This is supported by several studies that show a variety of effective doses that produce an optimal analgesic effect, thus a research plan was developed to discover the effective dose of propolis extract on suppressing pain response in mice using the writhing test method. Purpose: To determine the effective dose of propolis extract towards pain response in mice. Methods: This study was conducted using the writhing test method to see the analgesic effect of propolis extract. The research sample consisted of 30 mice which were divided into five treatment groups, namely the piroxicam control group, and the propolis extract group at doses of 35 mg/kgBW, 70 mg/kgBW, 105 mg/kgBW, 140 mg/kgBW. Results: The results showed that the propolis extract dose of 70 mg/kgBW had no significant difference with the piroxicam control group, while between the doses of 35 mg/kgBW, 105 mg/kgBW, 140 mg/kgBW there was a significant difference towards the piroxicam control group. Conclusion: Propolis extract 70 mg/kgBW is the effective dose in suppressing pain response in mice

Assessment of Concordance between Chairside Ultrasonography and Digital Palpation in Detecting Myofascial Trigger Points in Masticatory Myofascial Pain Syndrome

IntroductionMasticatory myofascial pain is a musculoligamentous syndrome that can mimic odontogenic pain. Pain referral to odontogenic structures can be traced to hyperirritated myofascial trigger points (MTrPs). This pragmatic study evaluated the concordance between ultrasonography and palpation in detecting MTrPs in the masseter and temporalis muscles. MethodsFifty-seven patients suspected to have temporomandibular disorder were included. MTrPs were palpated manually by expert clinicians. Ultrasonography was then performed by a blind sonographer. The quantity of MTrPs and the involved muscle sections, the pain occurrence, and the location of the MTrPs within the muscle sections were compared using the mean difference (MD) and concordance statistics (Cohen κ and the interclass correlation coefficient [ICC]) as applicable. ResultsUltrasonography located MTrPs as 2.1 ± 1.3 mm2 hypoechoic nodules at a depth of 7 ± 3.3 mm. Ultrasonography moderately agreed with palpation on the quantity of MTrPs per patient (MD = 1; 95% confidence interval [CI], 0.06–1.9; ICC = 0.56; 95% CI, 0.32–0.72). Palpation detected marginally more involved muscle sections per patient (MD = 0.7; 95% CI, 0.06–1.34.05; ICC = 0.64; 95% CI, 0.44–0.77) with more pain occurrence per patient (MD = 1.4; 95% CI, 0.56–2.28; ICC = 0.13; 95% CI, −0.26 to 0.41). There was a discordance in the location of the MTrPs within the muscle sections per patient (κ = −0.46; 95% CI, −0.77 to −0.14). ConclusionsUltrasonography and palpation concurred moderately to substantially on the quantity of MTrPs and the involved muscle sections but disagreed on the location of the MTrPs within the muscle sections. Ultrasonography has the potential as a chairside diagnostic aid to help clinicians determine an accurate diagnosis, enhance patient experience during examination, and avoid unnecessary treatments that can mitigate the risk of iatrogenic damage.

MULTIDISCIPLINARY MANAGEMENT ON PEUTZ-JEGHERS SYNDROME SUSPICION: A CASE REPORT

A 15-year-old woman presented with maxillary odontogenic pain. Extraorally: multiple bluish and dark brown mucocutaneous maculae in periocular, perinasal, perioral skin, and in fingers of both hands. Intraorally: multiple dark brown maculae in gingival, palatine, labial, and bilateral buccal mucosa. She referred occasional abdominal pain. Patient was referred to oral and maxillofacial pathology because Peutz-Jeghers syndrome was suspected. She was also evaluated by pediatric, clinical genetics, and gastroenterology. Genetic-molecular tests, abdominal and pelvic ultrasound, endoscopy, and colonoscopy were requested. A nonspecific growth was detected in the left ovary, so the patient was referred to gynecology. The case is currently being followed, but due to the COVID-19 pandemic, not all complementary tests have been performed. Diagnosis and management of Peutz-Jeghers syndrome must be multidisciplinary by the presence of gastrointestinal polyps and higher risk for developing cancer. Dental surgeons are in a favorable position to make the initial suspicion of the disease.

Did the March 2020 lockdown cause an increase in patients presenting to the emergency department with odontogenic pain and infection? A single centre, retrospective analysis

On the 25 March 2020 the Chief Dental Officer (CDO) published guidance to restrict the provision of routine dental care in England due to the rapid spread of the severe acute respiratory syndrome Coronavirus 2 (COVID-19). We analysed the impact of the pandemic on the number of patients presenting with odontogenic pain and infection to the emergency department (ED) of an urban-based teaching hospital, the Bristol Royal Infirmary (BRI). Furthermore, we investigated the severity of infection at first presentation to the ED. The study period encompassed three phases that represented the stages of pandemic restrictions: phase 1 prior to lockdown measures, with no restrictions to dental practice; phase 2 during the government lockdown, with the severest restrictions on dental practices; and phase 3 following the ease of lockdown measures, with return to limited dental services. Data were collected retrospectively from electronic patient records (EPR) regarding adult patients presenting to the ED with dental pain. The rate of presentations (per week) was calculated for each timepoint and compared. A severity score was assigned to each patient using a grading system based on signs of clinical infection and treatment modality. Patients' presentations were analysed at each phase of the pandemic. There was a 42.8% increase in attendance with oral facial pain and infection to ED from phases 1 to 3. The COVID-19 pandemic resulted in restrictions to routine primary dental care services, which were deemed necessary to reduce the spread of the virus. However, this increased demand on secondary care services, as patients increasingly struggled to access primary dental care to manage dental pain.

Odontogenic Pain and Its Associated Factors in Children of Peshawar, Pakistan

Aims: To determine odontogenic pain and its associated risk factors in children’s presenting to a Pediatric Dentistry Department Khyber College of Dentistry Peshawar. Material and method: This cross-sectional study was conducted at the pediatric department of Khyber College of Dentistry Peshawar. A convenience method was adopted for sampling and data was collected through a pre-design structured Proforma filled in the outpatient department (OPD) of the pediatric dentistry department. Data were analyzed by using a statistical package for social science SPSS. Frequencies and percentages were obtained. Results: Overall three hundred and ninety-five (395) children were engaged in this study. In which 60% were male and 40% female. All the participants attributed some signs and symptoms of odontogenic pain enlisted in Proforma. Dental caries with 71% was the most common associated factor which caused odontogenic pain. Periodontitis was 4%. Dental trauma was 19%. Dental hypersensitivity was 1% and other factors like eruption pressure and para functional habits etc. were 4%. Conclusion: It is concluded from this study that all of the patients attending the pediatric dentistry department of Khyber College of Dentistry Peshawar were having odontogenic pain. Occurring mainly in the teeth that present dental caries. Most patients were male and a higher frequency of the pain was evident in the patient's age group ranging from 8-12 years i.e., in a mixed dentition period. The second peak frequency ‘of odontogenic pain was due to dental trauma. A total of five cases were reported, in which the cause of odontogenic pain was dental hypersensitivity which was the lowest percentage. Keywords: Odontogenic Pain, Dental Caries, Trauma, Hypersensitivity, and Periodontitis,