Toothache Research Articles

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 language using the PyCharm environment and the openai library to integrate the ChatGPT 4 API and the Streamlit library 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.

Can silver diamine fluoride reduce invasive treatments with general anesthesia?

This study aims to retrospectively evaluate the differences in dental treatments rendered in general anesthesia (GA) for patients who did or did not receive application of silver diamine fluoride (SDF) prior to GA. 1559 patients (≤6 years) who completed treatment with GA for caries at University of California San Francisco (UCSF) between 2015 and 2019 were included in the study. At baseline patients' electronic health record was reviewed to collect planned treatment, complete dental treatment and demographics. Patients were identified as SDF group (N = 335, 21.49%) or comparison (N = 1224, 78.51%). Dental treatments rendered were compared between the SDF and comparison group with multi-variable regression, including variables for demographics and clinical findings at baseline. The initial analysis identified variations in gender, age, dental pain, pulp involvement, and initial treatment plans between the SDF and comparison groups at baseline. In an unadjusted analysis, the SDF group displayed a statistically significant increase in the number of crown procedures but a notable decrease in the number of pulp therapy and extraction treatments completed (p < 0.05). An adjusted multivariable model affirmed the inverse relationship between SDF application and completion of pulp therapy and extractions at the time of GA (p < 0.05). No significant association was identified with the total number of crowns needed and SDF. The model further indicated a positive correlation between the total count of pulp therapy and extractions completed with patient age and the wait-time for GA. In conclusion, pre-GA application of SDF to carious primary teeth is negatively correlated with completed pulp therapy and extraction. SDF application prior to dental treatment with GA may be a valuable tool to reduce invasive dental procedures in GA.

Association between dental anxiety, state anxiety and procedural pain during maxillary local anesthesia: a cross-sectional study

Association between dental anxiety, state anxiety and procedural pain during maxillary local anesthesia: a cross-sectional study

Malocclusion traits as risk indicators for depression in young adults: A population-based cross-sectional study

BackgroundAlthough malocclusion has historically drawn attention for its effects on craniofacial development, oral function, and aesthetics, recent studies have started to investigate the possible association between malocclusion and other aspects of overall health, such as mental health. ObjectivesThis study aimed to analyze various dental malocclusion characteristics and their potential association with depressive symptoms among young adults. The National Health and Nutrition Examination Survey was used for data procurement. MethodsThis cross-sectional study was conducted using a nationally representative population sample, including data from 3,806 participants surveyed between 1988 and 1994 under the National Health and Nutrition Examination Survey III. The inclusion criteria were completion of the clinical assessment for malocclusion traits, being dentate, reporting no history of previous or current orthodontic treatment, reporting no dental pain, and responding to a questionnaire about psychiatric status. Statistical evaluations involved logistic regression modeling and chi-squared tests, considering the complex sampling design nature of the survey. ResultsCrude and adjusted logistic regression models indicated no significant association between malocclusion traits and major depressive episodes (MDEs). Conversely, the same models revealed a positive association between malocclusion traits (specifically, upper crowding and two or more cumulative malocclusion traits) and dysthymia in both crude and adjusted analyses. ConclusionSpecific malocclusion traits were associated with dysthymia, whereas no such associations existed with MDEs. These findings suggest that the association between malocclusion and depression is complex and multifaceted.

Self-medication for dental caries-associated toothache among dental outpatients attended at public health facilities in Dar es Salaam, Tanzania: A cross-sectional study.

Self-medication is a common practice worldwide, and its prevalence ranges between 20% and 80% among patients suffering from dental pain. The socioeconomic status of an individual plays a key role in self-medication practice, especially sex and education level. This study aims to investigate the extent of self-medication practice for toothache due to dental caries among adults in Dar es Salaam, Tanzania. This was an analytical cross-sectional study carried out over 6 months. It included adult patients presenting with toothache in public dental clinics. A questionnaire captured information on demography, self-medication practice, the substance used for self-medication, duration of self-medication, and reason for self-medication. Univariate analysis was carried out to assess factors associated with self-care remedies. The probability level of α < 0.05 was selected for statistical significance. A total of 420 participants took part in this survey with a majority (54.3%) being females. The ages of the participants ranged between 18 years and 79 years, with a mean age of 33.37 (SD = 12.64) years. Nearly all (98.5%) participants used some sort of self-prescribed remedies for managing toothache before attending a dental clinic for appropriate treatment. The sociodemographic status of the participants did not influence the practice of self-medication. About 98% of patients suffering from toothache in Tanzania practice self-medication, and it cuts across all social strata of the adult dental population. Patients with toothache secondary to dental caries participated in the pilot study and were consulted on the suitability of the study tool.

Oral Health and Quality of Life in People with Autism Spectrum Disorder.

This article delves into the intricate relationship between oral health, quality of life, and behavioral characteristics in individuals with autism spectrum disorder (ASD). Background/Objectives: Autism has been associated with various challenges, and this study seeks to elucidate the impact of ASD on oral health outcomes and overall well-being. The research focuses on assessing overall oral health by evaluating various parameters, such as the condition of lips, tongue, gums and tissues, natural teeth, dentures, oral hygiene, and dental pain in individuals with ASD. Additionally, the study explores the influence of age, sex, and certain variables, like basic daily living skills on oral health practices, aiming to identify potential correlations between these factors and oral health outcomes. Methods: We employed standardized instruments to quantitatively measure and analyze the impact of oral health status on the overall quality of life experienced by individuals with ASD. Results: The study found a statistically significant positive association between oral health, measured by the Oral Health Assessment Tool (OHAT), and quality of life, as indicated by EuroQol 5-Dimensions Youth version (EQ-5D-Y) total scores (β = 0.13045, p = 0.00271). This suggests that better oral health is linked to higher quality of life. When adjusting for age and sex in a multiple linear regression model, the association remained significant but with a slightly reduced effect size (β = 0.10536, p = 0.0167). Age also showed a marginally significant positive association with quality-of-life scores. ANOVA results indicated that participants with advanced oral health status reported significantly higher quality-of-life scores than those with poorer oral health (p = 0.00246). The study also found that intelligence quotient (IQ) does not substantially influence dental health status, while the "Autonomy" subscale of the EQ-5D-Y is positively related to the OHAT. Conclusions: Unhealthy oral conditions significantly impact the overall quality of life in individuals with ASD. Therefore, it is crucial to include regular dental assessments and treatments in therapeutic protocols for patients with ASD.

Clinical efficacy study of position-responding mandibular advancement device in patients with obstructive sleep apnea.

Although mandibular advancement device (MAD) treatment is effective in patients with obstructive sleep apnea (OSA), there are still some concerns about its potential therapeutic and side effects. Thus, we developed a novel MAD that auto-titrates depending on its position in patients with OSA. Therefore, we conducted a clinical trial to determine the efficacy of an auto-titrating mandibular advancement device (AMAD) for treating OSA. Fourteen patients with OSA were enrolled in this study. Polysomnography (PSG) was conducted at the start of the clinical trial, and PSG with AMAD in situ was performed after three months of treatment. The mean Epworth Sleepiness Scale (ESS) and STOP-Bang scores were 8.21 ± 4.21 and 5.00 ± 1.00, respectively. After 3 months of treating AMAD, STOP-Bang scores improved to 3.75 ± 1.06; however, there was no significant change in ESS scores. Additionally, we found statistically significant improvements in several respiratory parameters in the PSG data after AMAD treatment. The AHI (32.85 ± 21.71 to 12.93 ± 10.70), supine AHI (45.91 ± 23.58 to 15.59 ± 12.76), lateral AHI (13.94 ± 10.95 to .49 ± 7.40), lowest O2 saturation (79.71 ± 6.22 to 84.00 ± 5.71), total arousal number (191.14 ± 112.07 to 86.57 ± 48.80), and arousal index (33.76 ± 21.00 to 15.05 ± 8.42) were recorded. However, there were no significant changes in total sleep time, sleep efficiency, or mean oxygen saturation. Additionally, we did not observe any major side effects during treatment, specifically related to tooth or jaw pain. Our clinical trial revealed that AMAD improved PSG parameters and reduced the incidence of common side effects. Therefore, AMAD may be an effective alternative treatment for OSA.

Experimental Investigation into the Anti-Inflammatory Properties of Curcumin for Orofacial Dental Pain Management

Experimental Investigation into the Anti-Inflammatory Properties of Curcumin for Orofacial Dental Pain Management

Main findings from the use of ozone therapy alone or combined with conventional treatments in root canal treatment: a systematic review

Introduction: The positive effects of ozone on biological properties include antimicrobial, immunostimulating, and biosynthetic impacts used in the treatment and maintenance of good oral hygiene. Ozone results in alteration in the metabolism of cells by raising the partial pressure of oxygen in tissues which improves the transporting capacity of oxygen in the blood. Ozone causes more blood supply to the ischemic zones due to surgical interventions like tooth extractions and implant placement. In this context of decontamination of root and periapical canals, ozone has emerged as an important sanitizer. Objective: It was to develop a systematic review of the literature to list the main findings of the use of ozone therapy alone or combined with conventional treatments in the treatment of root canals. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from March to June 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 122 articles were found, 35 articles were evaluated in full and 11 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 25 studies with a high risk of bias and 22 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=88.5%&lt;50%. Results and Conclusion: It is concluded that ultrasonic and sonic ozone activation resulted in less pain in patients undergoing single-session endodontics compared to no ozone treatment. Ozonated olive oil with zinc oxide and olive oil paste with zinc oxide demonstrated good clinical and radiographic success for pulpectomy of primary teeth. Furthermore, low-intensity laser and ozone therapy are useful methods for postoperative pain in vital symptomatic teeth, but they are not superior to each other.

Assessment of dental hard tissues and periodontium in children with hemophilia

Relevance. Children suffering from hemophilia primarily receive dental care when they present with acute tooth pain or exacerbation of an existing condition. Due to the rarity (orphan nature) of hereditary coagulopathies, dentists often lack the experience and knowledge to utilize modern methods of prevention and treatment for this patient category. Additionally, the lack of regular dental check-ups for children with hemophilia often leads to a high level of oral morbidity and a need for specific treatments, as indicated by literature data.Materials and methods. The primary methods used to assess oral health in children with hemophilia included detailed questioning, detection of carious lesions in dental hard tissues, assessment of oral hygiene, and the condition of periodontal tissues.Results. Among pediatric patients with hemophilia, poor oral hygiene was associated with a high prevalence of carious lesions (100%) and very high caries intensity values (8.8, ranging from 7 to 11). Additionally, there was a relatively high prevalence of gingival inflammation, accompanied by pronounced gingival bleeding. A direct correlation was identified between the level of oral hygiene and the degree of gingival bleeding in children aged 6-17 years with hemophilia. The deterioration of dental indicators corresponded to the severity of hemophilia, the primary disease in these children.Conclusion. The study demonstrated that pediatric patients with hemophilia, particularly those with moderate to severe forms, had significantly worse indicators of oral hygiene, dental hard tissues, and gingival health compared to generally healthy children. The results indicate the necessity for dental monitoring and rehabilitation for children with hemophilia to detect and effectively treat oral diseases at early stages.

Impact of the COVID-19 Pandemic on Saudi Parents' Perceptions Toward Their Children's Oral Health: A Cross-Sectional Study.

Background The coronavirus disease 2019 (COVID-19) markedly affected all aspects of life. Pediatric dentistry and oral health of children faced a challenging situation during the pandemic. Aim This study aimedto assess the attitude of Saudi parents toward their children's oral health and dental treatment during the COVID-19 pandemic. Methods This online-based cross-sectional study was conducted using a structured questionnaire adopted from previous studies with some modifications. It was distributed among 385 Saudi parentsrecruited through social media. It included questions regarding demographic data, parents' attitudes toward their children's dental care and dental visits during the COVID-19 pandemic, their fear level and willingness to take their children to dental appointments, and the parent's perception of dental clinics with regard to the COVID-19 spread. Descriptive statistics and the chi-squaretest were used; statistical significance was set at a p-value < 0.05. Results Different levels of fear of the pandemic were expressed by Saudi parents, with 42 (10.9%) showing maximum fear while 36 (9.3%) reported no fear. Although about half of the parentsstated that their children experienced dental pain during the pandemic, only 97 (25.1%) looked for dental care and were assisted. There was a significant association (p < 0.05) between the fear level with the family income and parents' willingness to take their children to dental appointments. Conclusions COVID-19 has hada great impact on parents' attitudes towards their children's oral health. A high percentage of Saudi parents' stated that they would take their children to dental clinics during the pandemic only for urgent treatment and severe pain.

Pharmacotherapy in dental pain: a review

Orofacial pain is the most important factor that must be fully controlled in dental practice; Poor pain management at the first level of care can have consequences for the patient such as worry, discomfort, fatigue, lack of appetite and alterations in their systemic health. It is therefore essential to provide a practical and easily accessible therapy in the dental office. as is pharmacotherapy. Non-steroidal anti-inflammatory analgesics are the drugs mostly used to control postoperative pain after dental treatments, and the use of analgesics for prolonged periods or a combination of these to achieve success in controlling dental pain is uncommon.

Spatiotemporal regulation of dental pulpal innervation in the rat.

The dental pulp is a highly innervated tissue transmitting pain-related sensations in the tooth. Consequently, understanding the intricacies of its innervation mechanism in odontogenesis is crucial for gaining insights into dental pain and developing dental pain-modulating agents. This study examined neuroregulatory molecules such as neurotrophic factors (nerve growth factor [NGF], brain-derived neurotrophic factor [BDNF], neurotrophin-4 [NTF-4], and neurturin [NRTN]) and neuroinhibitory factors (slit2, ephrin isoforms and netrin-1) in developing rat teeth with follicles. NGF, BDNF and NRTN transcriptions showed time-dependent upregulation, particularly during the root formation stage. In contrast, NTF-4 mRNA was highly expressed at the cap stage, but became downregulated over time. Slit2 and ephrin-B2 expression was distinct at the cap stage and then downregulated in a time-dependent manner. Ephrin-A5 and netrin-1 expression did not significantly change. Immunofluorescence analysis revealed a robust expression of both ephrin-B2 and slit2 in the outer and inner dental epithelia of the enamel organ, a non-neurogenic tissue, during the cap stage of 3rd molar germs. In contrast, BDNF was predominantly localized in dental papilla cells and odontoblasts during the root formation stage. These results suggest that neuroregulatory molecules, such as BDNF, slit2 and ephrin-B2, may be important in identifying therapeutic targets for modulating dental pulp pain.

The Essential Guide to Managing morphological oddity of Two-rooted Mandibular Premolar: A case report with review of 10 years incidence

Introduction- The root canal morphology of teeth is often extremely complex and highly variable. One such morphological oddity is the presence of two roots, with a reported incidence of 1.8%. Case- A 16-year-old female patient complains of pain in the posterior left mandibular tooth for the past 2 weeks. After clinical, radiographic examination, and vitality testing, we diagnosed the patient with Acute apical periodontitis of tooth #34. It was decided to treat the left mandibular first premolar with two roots endodontically. The patient was reviewed after 1 month, 3 months, 6 months , 1 year and radiographs showed satisfactory healing. Conclusion- This case report details the endodontic management of a sparse case of mandibular first premolar with two roots and two canals, which ended with a favorable outcome due to the satisfactory execution of the preferred constituents.

Recurring Transient Tooth Pain as Newly Described Symptom of Migratory Loiasis: A Mixed-Methods Study in Rural Gabon.

Loiasis, a filarial pathogen exclusively endemic in central and western Africa, causes a wide spectrum of symptoms. Understanding the breadth of its clinical manifestations is of importance for adequate patient care and to understand its disease burden. Recurring transient pain in the oral cavity was reported as a self-perceived symptom of loiasis in in-depth interviews of patients in a high transmission region in Gabon. Pain was described as stabbing in character and transient for a few days in its temporal course. A quantitative epidemiological survey indicated that transient tooth pain was experienced by 22% of patients infected with Loa loa. Among those individuals, it was exclusively reported by patients suffering from migratory loiasis (24%). Similar findings have been previously described for other filarial pathogens, indicating that transient swellings of the periodontium and the soft tissue of the oral cavity may explain this symptom reported by patients with migratory loiasis.

Caries prevalence among children at public and private primary schools in Riyadh: a retrospective study

Dental caries is a global oral health issue, especially critical in children, affecting their growth, nutrition, and education due to school absences or distractions from dental pain. The aim of the study was to investigate the correlation between school types (indicative of socioeconomic conditions) and dental caries prevalence among primary school children in Riyadh, alongside assessing the overall caries prevalence among schoolchildren in Riyadh. Retrospective study on 28,343 first and fourth-grade students from 960 public and private schools in Riyadh, using data from the Saudi Ministry of Health (Feb-April 2019). Utilized the DMFT/dmft index for assessment and collected demographic data. Most of the schools were public (76.1%), private national (17.1%), and private international (6.8%). Overall, the mean DMFT index for permanent teeth and the dmft index for primary teeth were 1.78 and 1.94, respectively. 58% of school children had no dental caries, 25% had mild caries, and 17% had moderate to severe caries. Public school children showed a higher caries prevalence than private schools. Oral disease rates were higher in girls than in boys, and grade four students had a higher prevalence than grade one students. Saudi Arabia, a developing nation, faces challenges in addressing oral health, especially in public schools. Targeted initiatives are crucial for awareness, preventive measures, and meeting oral health needs.

A software-based observational coding approach for evaluating paediatric dental pain, anxiety, and fear.

Dental practitioners desire non-pharmacological methods to alleviate anxiety, fear, and pain in children receiving dental care; high-quality evidence, however, is required to evaluate methods' efficacy. This study aimed to develop and validate an observation-based coding approach (paediatric dental pain, anxiety, and fear coding approach [PAFCA]) to evaluate non-pharmacological behavior management techniques for anxiety, fear, and pain. Objective (video-based) and subjective (self-reported) anxiety, fear, and pain data were collected from a pilot clinical trial evaluating animal-assisted therapy (AAT) in paediatric dentistry, in which 37 children aged 7-14 were assigned to AAT or control before dental treatment (restorations or extractions). A coding approach utilizing a codebook, a gold standard calibration video, and a user training guide was developed. Trained examiners coded the gold standard video for inter-rater agreement, and masked, calibrated examiners analyzed videos using the Noldus Observer XT software. A novel, software-based coding approach was developed, with moderately high inter-rater agreement. Using PAFCA, we found children reporting higher levels of pain, fear, and anxiety exhibited treatment-interfering behaviors, including crying/moaning, attempts to dislodge instruments, and more upper and lower body movements. PAFCA shows promise as a reliable tool for assessing anxiety, pain, and fear in behavioral research for paediatric dentistry.

Parental Perspectives on Paediatric Dental Treatment under General Anaesthesia.

To investigate parental perceptions of comprehensive dental care under general anesthesia for their children. The study included parents of children who underwent comprehensive dental care under general anesthesia. Only parents who could communicate in English were included. They were invited to participate in a telephone interview within four weeks of their children's dental treatment under general anesthesia. The interviews were designed to gather information on three main domains: problems experienced before the operation, children's well-being after the operation, and satisfaction. A total of 45 parents participated in the study; 91.1% identified as women and 8.8% as men. Most parents resided in areas categorised as either more deprived (51%) or most deprived (24.4%), based on deprivation indices. Prior to surgery, 66.7% of children suffered from dental pain, 44.4% were affected by dental abscesses or facial swelling, 42.2% experienced difficulties with eating and drinking, while 37.8% experienced sleeping difficulties. Painkillers were used for a short duration to manage post-operative pain (48.9%). Four weeks after the operation, many parents reported improvements in their children's mouth comfort. They observed positive changes in their children's ability to eat (40%), sleep habits (33.3%), and overall health and well-being (82.2%). Overall, most parents expressed high levels of satisfaction with the care their children received (95.5%). Parents observed improvements in their children's oral health and reported high level of satisfaction with the procedures.

Impact of Cryotreated and Warm Sodium Hypochlorite on Postoperative Pain in Teeth With Symptomatic Irreversible Pulpitis: A Randomized Controlled Trial

IntroductionThe purpose of this study was to evaluate effect of cryotreated and warm sodium hypochlorite (NaOCl) on postoperative pain in patients with symptomatic irreversible pulpitis and symptomatic apical periodontitis. MethodsSixty-six individuals with preoperative pain scores of ≥54 mm on the Heft Parker Visual Analogue Pain Scale (HP-VAS) diagnosed with symptomatic irreversible pulpitis and symptomatic apical periodontitis as per the American Association of Endodontists guidelines in mandibular molars were included. The preparation of the access and the root canals was instrumented and irrigated in accordance with a standard protocol. Based on the temperature of the final irrigant, the root canals were then randomly assigned to 3 groups and 3% NaOCl was irrigated: control (at 25°C), cold NaOCl (2°C), and warm NaOCl (60°C) (n = 22/group). Root canal treatment was completed at the same visit. Pre- and postoperative pain assessment at 6, 24, 48, and 72 hours was conducted using the HP-VAS, and analgesic consumption was noted. Suitable statistical tests were used to analyze the data. ResultsIn comparison with the other 2 groups, the cold NaOCl group had a lower HP-VAS score at all follow-up intervals. Between groups, there was a statistically significant difference in postoperative pain scores at 6 and 72 hours (P < .05). None of the subjects experienced any postoperative discomfort at 72 hours in the control and cold NaOCl groups. ConclusionPatients treated with cold NaOCl as the final irrigant experienced significantly less postoperative pain at 6 hours when compared with room temperature and warm NaOCl.

A rare case of an aggressive polymorphous adenocarcinoma of minor salivary gland in the retro-maxilla

Abstract Polymorphous adenocarcinoma (PAC) is a low-grade malignant tumour of minor salivary glands of the oral cavity, which rarely presents with invasive features. Low metastatic and excellent survival rates are some of its favorable features. A 36-year-old woman reported with swelling, pain, and mobility of teeth in the left upper inner cheek region. Contrast enhanced computed tomography (CECT) revealed a large, lobulated, heterogenous mass in the left retro-maxillary region with a few enlarged left cervical lymph nodes (levels IB and II). After surgery, the final histopathology report gave a definitive diagnosis of PAC with certain invasive characteristics – perineural invasion, infiltration into skeletal muscle, and depth of invasion of 10 mm, which recurred in a different location 1.5 years later. A few predictable features of PAC include incidence in elderly women, asymptomatic presentation, occurrence in the posterior hard of soft palate, very low incidence of nodal or distant metastases, perineural spread, skeletal muscle infiltration, and low rates of recurrence with good survival outcomes. However, in our case, the patient appeared to present with a relatively aggressive form of PAC, considering her young age, symptomatic presentation, uncommon anatomic location in the retro-maxilla, cervical nodal metastasis, perineural and skeletal muscle infiltration, and local recurrence within a short period. Although PAC is a low-grade tumour with excellent prognosis, it may occasionally present with invasive characteristics, and early diagnosis and prompt management with strict adherence to post-operative regimens and follow-up is of prime importance to prevent any untoward outcomes.