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International Endodontic Journal Oct 2022To review variables and management techniques that may affect anaesthesia failure during root canal treatment and methods of overcoming anaesthesia failure. (Review)
Review
AIM
To review variables and management techniques that may affect anaesthesia failure during root canal treatment and methods of overcoming anaesthesia failure.
METHODOLOGY
The PubMed and Cochran databases were searched for evidence-based investigations regarding pain during needle insertion, pain on injection, efficacy of the anaesthetic solutions and anaesthesia techniques, and premedication.
RESULTS
Variables such as pain on injection, premedication with various types of drugs, volume of anaesthetic solutions, supplemental anaesthetic techniques, and additives to the anaesthetic solutions may influence pain perception during root canal treatment. Differences between teeth with healthy pulps versus those with irreversible pulpitis should be considered when the effects of variables are interpreted. However, there are several concerns regarding the methodology of investigations that have evaluated anaesthesia success rates.
CONCLUSION
Several variables may influence anaesthesia success rates. There are conditions that may help to predict a patient's pain during endodontic procedures. These conditions could be overcome either by employing methods such as premedication with a non-steroidal anti-inflammatory drug prior to the treatment visit or by using supplementary techniques before or during the treatment. However, investigators need to be more careful when reporting details of their studies to reduce concerns regarding their study bias.
Topics: Humans; Anesthetics, Local; Mandibular Nerve; Nerve Block; Pulpitis; Anesthesia, Dental; Pain; Anti-Inflammatory Agents; Lidocaine
PubMed: 35119117
DOI: 10.1111/iej.13697 -
International Endodontic Journal Dec 2023This study aimed to compare the outcome of SCR and Pulpotomy in teeth with deep caries extending at least 75% into dentine. (Randomized Controlled Trial)
Randomized Controlled Trial
AIM
This study aimed to compare the outcome of SCR and Pulpotomy in teeth with deep caries extending at least 75% into dentine.
METHODOLOGY
This two-armed, parallel-group, randomized, superiority trial included vital mature permanent teeth with deep primary or secondary caries diagnosed radiographically as being at least 75% into the thickness of dentine, without clinical signs of symptomatic irreversible pulpitis or radiographic evidence of a periapical lesion. Carious teeth were blindly allocated to receive either SCR or Pulpotomy using computer-generated randomized patient codes concealed in opaque envelopes. All teeth were reviewed clinically and radiographically at 6 months and 1 year post-treatment. Using a significance level of p < .05, the log rank test and Cox proportional hazards regression were used to compare the outcome of SCR and Pulpotomy and to identify potential prognostic factors, respectively.
RESULTS
In all, 58 teeth in the SCR group and 55 teeth in the pulpotomy group completed treatment, after excluding 6 teeth because they did not complete the allocated treatment and another due to severe periodontal disease. At one year, 57/58 (98.3%) teeth from the SCR group and 48/55 (87.3%) teeth from the Pulpotomy group were available for analysis. One tooth in the Pulpotomy group (2.1%) and eight teeth in the SCR group (14.0%) required the further intervention of root canal treatment (p < .05). There were no other significant prognostic factors for survival. Overall, 91.4% of teeth treated with either SCR or Pulpotomy survived without requiring further intervention over a period of one year. No other adverse events occurred over the review period.
CONCLUSION
Within the limitations of this study, Pulpotomy fares better than SCR in preserving the remaining pulp and periapical health. As a treatment modality, Pulpotomy carries greater cost outlay to patient and takes a longer time to complete treatment than SCR. Long-term follow-up is needed to study the pulpal and restorative outcomes of Pulpotomy and SCR.
Topics: Humans; Pulpotomy; Dental Caries Susceptibility; Pilot Projects; Calcium Compounds; Treatment Outcome; Pulpitis; Dental Caries; Silicates
PubMed: 37795835
DOI: 10.1111/iej.13978 -
JDR Clinical and Translational Research Apr 2022The aim of this 2-arm, parallel-group, 12-mo randomized clinical trial was to compare the effectiveness of semiannual application of 38% silver diamine fluoride (SDF)... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
The aim of this 2-arm, parallel-group, 12-mo randomized clinical trial was to compare the effectiveness of semiannual application of 38% silver diamine fluoride (SDF) versus restorative treatment (RT) to manage cavitated caries lesions in primary teeth in a diverse population of children in Michigan.
METHODS
Children aged 2 to 10 y with at least 1 soft cavitated lesion (International Caries Detection and Assessment System 5 or 6) with no pain or signs/symptoms of irreversible pulpitis were recruited and randomly assigned to 2 intervention groups. One random lesion per child received 38% SDF (twice, at a 6-mo interval) or RT. All interventions and assessments were done by calibrated dentists. Primary outcome measures were clinical failure rates: minor (e.g., reversible pulpitis, active/soft lesion or progression, restoration loss or need for replacement/repair, secondary caries) and major (e.g., irreversible pulpitis, abscess, extraction). Parent, child, and provider acceptability was also assessed.
RESULTS
Ninety-eight children were enrolled and randomized, with a mean (SD) age of 4.8 y (1.8); 46% were female and their mean dmft + DMFT was 6.3 (3.9). Sixty-nine children were assessed at 12 mo (sample was within the planned 30% attrition rate). There were significantly more teeth with minor failures (SDF = 65%, RT = 23%, ≤ 0.001) and major failures (SDF = 13%, RT = 3%, ≤ 0.001) in the SDF group than the RT group; 74% of SDF-treated lesions were hard at 12 mo vs. 57% at 6 mo. Providers stated that SDF was easier, faster, and more preferable than RT ( ≤ 0.001). No significant differences were found in parental satisfaction and acceptability. At 12 mo, children in the RT arm felt significantly ( < 0.05) happier with their tooth appearance and stated that their visit to the dentist hurt less.
CONCLUSION
At 12 mo, SDF-treated lesions had significantly more minor and major failures than RT, suggesting that SDF-treated teeth need to be closely monitored in a population at high caries risk (ClinicalTrials.gov NCT02601833).
KNOWLEDGE OF TRANSFER STATEMENT
The results of this study can be used by clinicians when deciding whether to restore or apply silver diamine fluoride to cavitated lesions in primary teeth. Information on treatment outcomes and parent, child, and provider acceptability can help guide appropriate treatment decisions and need for monitoring.
Topics: Cariostatic Agents; Child; Dental Caries; Female; Fluorides, Topical; Humans; Male; Pulpitis; Quaternary Ammonium Compounds; Silver Compounds
PubMed: 35120408
DOI: 10.1177/23800844211072741 -
Acta Odontologica Scandinavica May 2023The aim was to compare the cost-effectiveness of partial caries removal (PCR) and stepwise caries removal (SW) in mature permanent teeth diagnosed with deep caries... (Review)
Review
OBJECTIVE
The aim was to compare the cost-effectiveness of partial caries removal (PCR) and stepwise caries removal (SW) in mature permanent teeth diagnosed with deep caries lesions, in a Swedish Public Dental Care organization.
MATERIALS AND METHODS
A decision tree model was used to calculate the cost-effectiveness for PCR and SW. Probability values were obtained through a literature search in PubMed and Scopus. Treatment times were estimated by a group of dentists practicing at public dental care clinics in Västra Götaland county, Sweden.
RESULTS
The expected costs for PCR and SW were 187,63 and 414,35 €, respectively, indicating that PCR was more cost-effective. Four articles were identified through the literature search. The -values for PCR outcomes were 94% (success), 0% (pulp exposure) and 6% (pulpitis/apical periodontitis etc.). For SW, the -values were 76% (success), 2% (pulp exposure during the first visit), 13% (pulp exposure during the second visit) and 9% (pulpitis/apical periodontitis etc.).
CONCLUSIONS
Given the presumptions in this decision analysis, the PCR method used on mature permanent teeth is more cost-effective ( < ,05) compared to the SW method in protecting the pulp from exposure and avoiding the need for root canal treatment.
Topics: Humans; Pulpitis; Cost-Benefit Analysis; Dental Caries Susceptibility; Dental Care; Dental Caries; Periapical Periodontitis
PubMed: 36371711
DOI: 10.1080/00016357.2022.2143893 -
Frontiers in Immunology 2020A common feature of many acute and chronic oral diseases is microbial-induced inflammation. Innate immune responses are the first line of defense against pathogenic... (Review)
Review
A common feature of many acute and chronic oral diseases is microbial-induced inflammation. Innate immune responses are the first line of defense against pathogenic microorganisms and are initiated by pattern recognition receptors (PRRs) that specifically recognize pathogen-associated molecular patterns and danger-associated molecular patterns. The activation of certain PRRs can lead to the assembly of macromolecular oligomers termed , which are responsible for pro-inflammatory cytokine maturation and secretion and thus activate host inflammatory responses. About 10 years ago, the absent in melanoma 2 (AIM2) was independently discovered by four research groups, and among the "canonical" inflammasomes [including AIM2, NLR family pyrin domain (NLRP)1, NLRP3, NLR family apoptosis inhibitory protein (NAIP)/NLR family, caspase activation and recruitment domain (CARD) containing (NLRC)4, and pyrin], AIM2 so far is the only one that simultaneously acts as a cytosolic DNA sensor due to its DNA-binding ability. Undoubtedly, such a double-faceted role gives AIM2 greater mission and more potential in the mediation of innate immune responses. Therefore, AIM2 has garnered much attention from the broad scientific community during its first 10 years of discovery (2009-2019). How the AIM2 inflammasome is related to oral diseases has aroused debate over the past few years and is under active investigation. AIM2 inflammasome may potentially be a key link between oral diseases and innate immunity. In this review, we highlight the current knowledge of the AIM2 inflammasome and its critical role in the pathogenesis of various oral diseases, which might offer future possibilities for disease prevention and targeted therapy utilizing this continued understanding.
Topics: Animals; DNA-Binding Proteins; Humans; Immunity, Innate; Inflammasomes; Mouth Neoplasms; Pathogen-Associated Molecular Pattern Molecules; Periodontal Diseases; Pulpitis; Receptors, Pattern Recognition
PubMed: 32903550
DOI: 10.3389/fimmu.2020.01487 -
Disease Markers 2022Long noncoding RNAs (lncRNAs) are emerging as critical regulators of various biological processes, including immune regulation.
BACKGROUND
Long noncoding RNAs (lncRNAs) are emerging as critical regulators of various biological processes, including immune regulation.
METHODS
Due to the critical significance of immunological responses in the development and progression of pulpitis, we used an integrated algorithm to identify immune-related lncRNAs and then examined the lncRNA-immunity regulation network in pulpitis. Before identifying immune-related lncRNAs, the data from GEO datasets were precleaned. ConsensusClusterPlus was used to differentiate immune-related pulpitis subgroups. Enrichment analysis using GO and MSigDB databases was employed to determine the differences in molecular function, cellular component, and biological process between the two pulpitis subtypes.
RESULTS
An integrated algorithm was designed to filtrate immune-related lncRNAs accurately. 790 immune-related lncRNAs were found in 17 immunological categories, with 38 of them perturbated in pulpitis. The Cytoscape software was used to visualize the relationship between representative immune regulatory pathways and immune-related lncRNAs. Two immune-related pulpitis subtypes were discovered using differentially expressed immune-related lncRNAs. Subtype 2 has a stronger association with immune-related pathways than subtype 1 does.
CONCLUSIONS
Our study identified many immune-related lncRNAs and investigated potential lncRNA regulation networks; meanwhile, the molecular subtypes of pulpitis were identified, all of which will be relevant for further research into inflammatory and immunological processes in pulpitis.
Topics: Algorithms; Gene Regulatory Networks; Humans; Pulpitis; RNA, Long Noncoding; Software
PubMed: 35711564
DOI: 10.1155/2022/7222092 -
International Journal of Molecular... Jan 2019Dental pain is a common health problem that negatively impacts the activities of daily living. Dentine hypersensitivity and pulpitis-associated pain are among the most... (Review)
Review
Dental pain is a common health problem that negatively impacts the activities of daily living. Dentine hypersensitivity and pulpitis-associated pain are among the most common types of dental pain. Patients with these conditions feel pain upon exposure of the affected tooth to various external stimuli. However, the molecular mechanisms underlying dental pain, especially the transduction of external stimuli to electrical signals in the nerve, remain unclear. Numerous ion channels and receptors localized in the dental primary afferent neurons (DPAs) and odontoblasts have been implicated in the transduction of dental pain, and functional expression of various polymodal transient receptor potential (TRP) channels has been detected in DPAs and odontoblasts. External stimuli-induced dentinal tubular fluid movement can activate TRP channels on DPAs and odontoblasts. The odontoblasts can in turn activate the DPAs by paracrine signaling through ATP and glutamate release. In pulpitis, inflammatory mediators may sensitize the DPAs. They could also induce post-translational modifications of TRP channels, increase trafficking of these channels to nerve terminals, and increase the sensitivity of these channels to stimuli. Additionally, in caries-induced pulpitis, bacterial products can directly activate TRP channels on DPAs. In this review, we provide an overview of the TRP channels expressed in the various tooth structures, and we discuss their involvement in the development of dental pain.
Topics: Activities of Daily Living; Adenosine Triphosphate; Dentin Sensitivity; Glutamic Acid; Humans; Neurons, Afferent; Odontoblasts; Protein Processing, Post-Translational; Pulpitis; Toothache; Transient Receptor Potential Channels
PubMed: 30691193
DOI: 10.3390/ijms20030526 -
Disease Markers 2021To identify the critical genetic and epigenetic biomarkers by constructing the long noncoding RNA- (lncRNA-) related competing endogenous RNA (ceRNA) network involved in...
AIM
To identify the critical genetic and epigenetic biomarkers by constructing the long noncoding RNA- (lncRNA-) related competing endogenous RNA (ceRNA) network involved in irreversible pulp neural inflammation (pulpitis).
MATERIALS AND METHODS
The public datasets regarding irreversible pulpitis were downloaded from the gene expression omnibus (GEO) database. The differential expression analysis was performed to identify the differentially expressed genes (DEGs) and DElncRNAs. Functional enrichment analysis was performed to explore the biological processes and signaling pathways enriched by DEGs. By performing a weighted gene coexpression network analysis (WGCNA), the significant gene modules in each dataset were identified. Most importantly, DElncRNA-DEmRNA regulatory network and DElncRNA-associated ceRNA network were constructed. A transcription factor- (TF-) DEmRNA network was built to identify the critical TFs involved in pulpitis.
RESULT
Two datasets (GSE92681 and GSE77459) were selected for analysis. DEGs involved in pulpitis were significantly enriched in seven signaling pathways (i.e., NOD-like receptor (NLR), Toll-like receptor (TLR), NF-kappa B, tumor necrosis factor (TNF), cell adhesion molecules (CAMs), chemokine, and cytokine-cytokine receptor interaction pathways). The ceRNA regulatory relationships were established consisting of three genes (i.e., LCP1, EZH2, and NR4A1), five miRNAs (i.e., miR-340-5p, miR-4731-5p, miR-27a-3p, miR-34a-5p, and miR-766-5p), and three lncRNAs (i.e., XIST, MIR155HG, and LINC00630). Six transcription factors (i.e., GATA2, ETS1, FOXP3, STAT1, FOS, and JUN) were identified to play pivotal roles in pulpitis.
CONCLUSION
This paper demonstrates the genetic and epigenetic mechanisms of irreversible pulpitis by revealing the ceRNA network. The biomarkers identified could provide research direction for the application of genetically modified stem cells in endodontic regeneration.
Topics: Biomarkers; Epigenesis, Genetic; Gene Regulatory Networks; Humans; Pulpitis; Transcriptome
PubMed: 33777260
DOI: 10.1155/2021/8831948 -
Anesthesia Progress 2018The aim of this study was to provide an evidence-based answer to the question: "Is 3.6-mL volume of an anesthetic agent more effective than 1.8-mL volume in providing... (Meta-Analysis)
Meta-Analysis Review
The aim of this study was to provide an evidence-based answer to the question: "Is 3.6-mL volume of an anesthetic agent more effective than 1.8-mL volume in providing anesthesia for mandibular molars?" Following formulation of research question and keyword selection, a comprehensive search of the following databases was conducted: Cochrane library, PubMed, Scopus, Google Scholar, ProQuest, and Clinicaltrials.gov. Three-phase eligibility appraisal and quality assessment of the studies were carried out by 2 independent reviewers. To reduce clinical heterogeneity, the included studies were divided into 2 groups: studies on healthy teeth and studies on teeth with pulpitis. The data of included studies were statistically combined through meta-analysis using a fixed-effects model. A total of 20,778 records were initially retrieved from the search. Following screening and eligibility assessment, 8 studies met the eligibility criteria and were included for qualitative synthesis. Of those, 5 studies were qualified for meta-analysis. In the irreversible pulpitis group, increasing the volume of anesthetic agent from 1.8 to 3.6 mL significantly increased the success rate of inferior alveolar nerve block (risk ratio = 2.45, 95% CI: 1.67-3.59, p < .001). However, there was insufficient evidence to draw a conclusion regarding healthy teeth.
Topics: Anesthesia, Dental; Anesthesia, Local; Anesthetics, Local; Humans; Mandibular Nerve; Molar; Nerve Block; Pulpitis
PubMed: 29509518
DOI: 10.2344/anpr-65-01-03 -
Evidence-based Dentistry Dec 2021Aim To investigate the success rate of 'bidirectional' splinting - both internal and external - of teeth with longitudinal cracks and reversible pulpitis, as well as to... (Review)
Review
Aim To investigate the success rate of 'bidirectional' splinting - both internal and external - of teeth with longitudinal cracks and reversible pulpitis, as well as to identify any signs or symptoms that could give a prognostic indication of success.Design Cohort study.Cohort selection Thirty-four teeth from 33 patients visiting the Department of Conservative Dentistry at the Yonsei University Dental Hospital, Seoul, South Korea, between June 2016 and November 2017, diagnosed with longitudinal cracked teeth with reversible pulpitis. Teeth with signs of pulp necrosis, irreversible pulpitis or other types of longitudinal cracks were excluded.Data analysis These teeth were treated by a systematic protocol of initial external splinting with a metal band, crack removal and internal splinting with composite resin, placement of a temporary crown, before a final permanent crown. Symptoms and vitality were assessed at every stage and root canal treatment provided where deemed necessary. The teeth were then followed up for up to four years to assess tooth survival and pulp vitality.Results Accounting for five dropouts during the treatment protocol, 29 teeth reached at least a one-year recall. Of these, 21 (72%) had pulp survival, eight (28%) had required root canal treatment - six of those before final crown cementation - and zero teeth required extraction (100% survival rate). Cracked teeth without initial tenderness to percussion showed a 94% pulp survival rate, while those with tenderness had only a 46% pulp survival rate.Conclusions A systematic approach to treating cracked teeth with reversible pulpitis should be utilised to maintain tooth vitality and survival. Using a bidirectional splinting method provides good outcomes for these teeth. Tenderness to percussion is a significant prognostic indicator of pulp vitality and whether root canal treatment should be initiated.
Topics: Cohort Studies; Cracked Tooth Syndrome; Dental Pulp Necrosis; Humans; Pulpitis; Root Canal Therapy
PubMed: 34916646
DOI: 10.1038/s41432-021-0223-x