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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 -
The New York State Dental Journal Jan 2017Patients typically associate dental care with pain. Pain has both physiological and psychological components. Endodontic post-treatment pain continues to be a... (Review)
Review
Patients typically associate dental care with pain. Pain has both physiological and psychological components. Endodontic post-treatment pain continues to be a significant problem facing the dental profession. For patients presenting with preoperative pain, most will continue to experience pain after root canal treatment, with pain levels ranging from mild to severe. The purpose of this paper was to review the symptoms and classification of irreversible pulpitis, including acute and chronic pulpitis, incidence of postoperative pain following treating teeth with irreversible pulpitis, factors influencing postoperative pain, persistent pain after root canal treatment, preventing postoperative pain and pharmacological management of postoperative pain.
Topics: Humans; Pain, Postoperative; Pulpitis; Root Canal Therapy
PubMed: 29919992
DOI: No ID Found -
Journal of the American Dental... May 2023The authors assessed the clinical effectiveness of analgesics to manage acute pain after dental extractions and pain associated with irreversible pulpitis in children. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The authors assessed the clinical effectiveness of analgesics to manage acute pain after dental extractions and pain associated with irreversible pulpitis in children.
TYPES OF STUDIES REVIEWED
The authors searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and US Clinical Trials registry from inception through November 2020. They included randomized controlled trials comparing any pharmacologic interventions with each other and a placebo in pediatric participants undergoing dental extractions or experiencing irreversible pulpitis. After duplicate screening and data abstraction, the authors conducted random-effects meta-analyses. They assessed risk of bias using the Cochrane Risk of Bias 2.0 tool and certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation approach.
RESULTS
The authors included 6 randomized controlled trials reporting 8 comparisons. Ibuprofen may reduce pain intensity compared with acetaminophen (mean difference [MD], 0.27 points; 95% CI, -0.13 to 0.68; low certainty) and a placebo (MD, -0.19 points; 95% CI, -0.58 to 0.21; low certainty). Acetaminophen may reduce pain intensity compared with a placebo (MD, -0.13 points; 95% CI, -0.52 to 0.26; low certainty). Acetaminophen and ibuprofen combined probably reduce pain intensity compared with acetaminophen alone (MD, -0.75 points; 95% CI, -1.22 to -0.27; moderate certainty) and ibuprofen alone (MD, -0.01 points; 95% CI, -0.53 to 0.51; moderate certainty). There was very low certainty evidence regarding adverse effects.
PRACTICAL IMPLICATIONS
Several pharmacologic interventions alone or in combination may provide a beneficial effect when managing acute dental pain in children. There is a paucity of evidence regarding the use of analgesics to manage irreversible pulpitis.
Topics: Child; Humans; Acetaminophen; Ibuprofen; Analgesics, Non-Narcotic; Acute Pain; Pulpitis; Analgesics
PubMed: 37105668
DOI: 10.1016/j.adaj.2023.02.013 -
General Dentistry 2021Irreversible pulpitis is an acute, brief, and painful condition. Oxytocin, cortisol, and secretory immunoglobulin A (sIgA) are released by the body in response to pain...
Irreversible pulpitis is an acute, brief, and painful condition. Oxytocin, cortisol, and secretory immunoglobulin A (sIgA) are released by the body in response to pain and emotional stress. The aim of this study was to investigate the expression of salivary cortisol, sIgA, and oxytocin among patients with irreversible pulpitis. This was an ethically approved case-control study comparing 90 cases of irreversible pulpitis and 40 healthy individuals. Five study groups were established: nonpregnant female pulpitis, pregnant female pulpitis, male pulpitis, healthy (nonpregnant) female control, and healthy male control. Pregnant women in the first trimester were enrolled in the study. Participants received both clinical and radiographic examinations, completed a simple questionnaire related to food intake, habits, and anxiety, and their pain levels were recorded on a visual analog scale in which 0 represented no pain and 10 represented the worst possible pain. Unstimulated saliva samples were collected to measure oxytocin, sIgA, and cortisol levels. Dental pulp specimens were obtained and stained with hematoxylin and eosin to evaluate the agreement between clinical and histologic pulpal diagnoses. The statistical analysis included analysis of variance and Tukey tests. The majority of patients (37%) recorded a score of 8 (severe pain) on the visual analog scale, while a score of 10 (worst possible pain) was recorded only by pregnant women (3%). There was no statistically significant difference among healthy subjects for all salivary samples. Oxytocin levels increased significantly in nonpregnant (P < 0.5) and pregnant (P < 0.001) women with pulpitis. Cortisol (P < 0.01) and sIgA (P < 0.001) levels were significantly elevated only in pregnant women with pulpitis. The results of the present study indicate that acute dental pain during pregnancy can be considered as a pregnancy risk factor because of the resulting elevated oxytocin and cortisol levels.
Topics: Case-Control Studies; Female; Humans; Male; Oxytocin; Pain; Pregnancy; Pulpitis; Risk Factors
PubMed: 33908883
DOI: No ID Found -
International Endodontic Journal Oct 2023To assess the clinical and radiographic outcome of partial pulpotomy by comparing MTA Angelus and Total Fill BC, as pulpotomy agents, in mature teeth with deep caries... (Randomized Controlled Trial)
Randomized Controlled Trial
Treatment outcome of partial pulpotomy using two different calcium silicate materials in mature permanent teeth with symptoms of irreversible pulpitis: A randomized clinical trial.
AIM
To assess the clinical and radiographic outcome of partial pulpotomy by comparing MTA Angelus and Total Fill BC, as pulpotomy agents, in mature teeth with deep caries and symptoms indicative of irreversible pulpitis.
METHODOLOGY
The study was designed as a parallel-two arm, double-blind, randomized superiority clinical trial registered at www.
CLINICALTRIALS
gov (NCT04870398). Symptomatic mature permanent teeth with deep caries fulfilling the inclusion criteria were randomly treated using either MTA Angelus or Total Fill BC. A partial pulpotomy was performed and following complete haemostasis, the capping material was placed over the remaining pulp tissue and a postoperative periapical radiograph was taken. Clinical and radiographic follow-up evaluation was performed for a median time of 2 years, whereas levels of pain intensity were evaluated preoperatively and for 7 days after intervention using Visual Analogue Scale. For the primary outcome (failure/success of treatment), the Kaplan-Meier survival curves for the capping materials were plotted and a log-rank test for equality of survivor functions was applied. A multivariable random effects Cox Regression model was also applied. For the secondary outcome (postoperatively reported pain), a multivariable mixed effects ordinal logistic regression was structured.
RESULTS
One hundred and thirty-seven teeth in 123 patients underwent partial pulpotomy using randomly either MTA Angelus (N = 74) or Total Fill BC (n = 63). The percentage failure for MTA Angelus and Total Fill BC was 10.8% (8/74) and 17.5% (11/63), respectively, but the difference was not statistically significant [adjusted HR: 1.83; 95% confidence interval (CI): 0.68, 4.91; p = .23]. Weak evidence was found that secondary caries involvement may impose a 3.54 times greater hazard for treatment failure (adjusted HR: 3.54; 95% CI: 1.00, 12.51; p = .05). For each passing minute of procedural bleeding control, there was also a 57% higher hazard for treatment failure (adjusted HR: 1.57; 95% CI: 0.99, 2.48; p = .05). The odds for higher postoperative pain were 4.73 times greater for the Total Fill BC compared to MTA Angelus (adjusted OR: 4.73; 95% CI: 2.31, 9.66; p < .001).
CONCLUSIONS
Both materials exhibited similar and favourable outcome rates after partial pulpotomy in teeth with deep caries and symptoms of irreversible pulpitis. Total Fill BC was associated with a higher level of postoperative pain intensities.
Topics: Humans; Pulpitis; Pulpotomy; Calcium Compounds; Silicates; Oxides; Treatment Outcome; Drug Combinations; Aluminum Compounds
PubMed: 37452640
DOI: 10.1111/iej.13955 -
MicroRNA and their implications in dental pulp inflammation: current trends and future perspectives.Odontology Jul 2023MicroRNAs (miRNAs) are short, 19-23 nucleotide non-coding RNA molecules that regulate gene expression by silencing or degrading the target mRNA gene. Since their... (Review)
Review
MicroRNAs (miRNAs) are short, 19-23 nucleotide non-coding RNA molecules that regulate gene expression by silencing or degrading the target mRNA gene. Since their discovery in the nineties of the last century, they have emerged as key inflammatory regulators. Inflammation induces the synthesis of various miRNAs that modulate the expression of multiple molecules involved in orchestrating the inflammatory response. This review aims to provide an insight into the role of miRNAs as potential biomarkers, mediators, and potential therapeutic targets of dental pulp inflammation. A literature search was conducted using the keywords; biogenesis of microRNA, human dental pulp cells, pulpitis, and inflammation in PubMed and Scopus index databases for all the published articles dealing with the role of miRNAs in pulp inflammation in the last 10 years. According to the literature, there is a clear correlation between miRNAs and several physiological events, as well as their role as mediators of innate immune response and inflammation in dental pulp cells. Our narrative review stipulates that numerous miRNAs play a key role in modulating inflammation, delaying or enhancing cell repair, cell differentiation, and survival in dental pulp diseases. However, further studies are required for the validation of miRNAs as reliable biomarkers in dental pulp pathology and their targeted therapy.
Topics: Humans; MicroRNAs; Dental Pulp; Inflammation; Pulpitis; Biomarkers
PubMed: 36309897
DOI: 10.1007/s10266-022-00762-0 -
Journal of Oral Rehabilitation Feb 2022Dental pulp tissues are rich in pain-related afferent nerve fibers, which originate from primary sensory neurons in the trigeminal ganglion (TG). The mechanisms of...
BACKGROUND
Dental pulp tissues are rich in pain-related afferent nerve fibers, which originate from primary sensory neurons in the trigeminal ganglion (TG). The mechanisms of central nervous system (CNS) underlying ectopic pain following peripheral inflammation have been reported that the macrophages as inflammatory and immunologic mediators in the TG play an important role in the process of pulpitis and hyperalgesia.
OBJECTIVE(S)
To observe the polarization response and dynamic distribution of macrophages in the TG during the development of dental pulp inflammation.
METHODS
A rat model of pulpitis was established using complete Freund's adjuvant (CFA). Hematoxylin-eosin (HE), immunohistochemistry (IHC), immunofluorescence (IF), toluidine blue (TB) staining, and RT-qPCR were performed to observe the expression of macrophage-related factors in the TG.
RESULTS
The results of IHC staining showed that M2 macrophages labeled with CD206 were observed in the TG of both the control and CFA groups. The statistical analysis indicated that the number of CD206-positive macrophages in the TG increased significantly at 24 h after CFA-induced pulpitis, reached a peak at 2 weeks, and then returned to the normal level after 6 weeks. The ratio of M2/M1 in the CFA groups was significantly lower than that in the control group from 24 to 72 h, and this pattern was reversed at 2 weeks after CFA-induced pulpitis; then, the ratio increased significantly and was maintained at a high level for 4 weeks. RT-qPCR results showed that the expression of IL-10 in the TG increased significantly from 1 to 4 weeks after CFA-induced pulpitis.
CONCLUSION
The trend of M2 macrophages was opposite to that of M1 macrophages in the TG during the process of pulpitis induced by CFA, which is consistent with the expression of macrophage-related cytokines. Macrophage polarization in the TG may participate in the neuroinflammation response induced by dental pulpitis.
Topics: Animals; Macrophages; Neuroinflammatory Diseases; Pulpitis; Rats; Rats, Sprague-Dawley; Trigeminal Ganglion
PubMed: 34398484
DOI: 10.1111/joor.13245 -
BioMed Research International 2022The indications of vital pulp therapy (VPT) are expanding, which cases are suitable for VPT, and how to improve the success rate of VPT is a problem that often bothers... (Review)
Review
The indications of vital pulp therapy (VPT) are expanding, which cases are suitable for VPT, and how to improve the success rate of VPT is a problem that often bothers us. The main purpose of VPT is to eliminate pulpitis by promoting the formation of reparative dentin or calcium bridge, so that it can continue to perform various physiological functions, and finally achieve the purpose of preserving pulp vitality and long-term preservation of affected teeth. Pulp capping and pulpotomy are the most common methods for VPT. The research field of VPT has attracted the attention of many scholars, who have studied it from many aspects (such as indications, material selection, operation requirements, and long-term prognosis). This article reviews the recent advances in the techniques of VPT in permanent teeth.
Topics: Calcium; Dental Care; Dental Pulp Capping; Humans; Prognosis; Pulpitis; Pulpotomy
PubMed: 36132084
DOI: 10.1155/2022/8788358 -
Clinical Oral Investigations Oct 2023There is a lack of studies evaluating the accuracy of the 2009 American Association of Endodontists (AAE) diagnostic criteria for diagnosing pulpal health in primary...
OBJECTIVES
There is a lack of studies evaluating the accuracy of the 2009 American Association of Endodontists (AAE) diagnostic criteria for diagnosing pulpal health in primary teeth. This study aimed to estimate and correlate the diagnostic accuracy of clinical diagnosis of reversible and irreversible pulpitis using the 2009 AAE criteria with histological findings in primary teeth.
METHODS
Eighty primary teeth that were clinically diagnosed with normal pulp (n = 10), reversible pulpitis (n = 30), irreversible pulpitis (n = 30) and pulp necrosis (n = 10) were collected. The teeth were histo-processed, and pulp tissues were diagnosed histologically as uninflamed pulp, reversible or irreversibly inflamed and necrosis based on previously proposed criteria.
RESULTS
The clinical diagnosis of pulp necrosis (sensitivity 70%, specificity 96%) and normal pulp (sensitivity 91%, specificity 100%) matched the histological diagnosis of necrosis and uninflamed pulp in 70% and 100%, respectively. The clinical diagnosis of irreversible pulpitis (sensitivity 64%, specificity 72%) matched the histological diagnosis of irreversible pulp inflammation for 47% of teeth evaluated. For the clinical diagnosis of reversible pulpitis (sensitivity: 65%, specificity: 86%), 80% matched the histological diagnosis of reversible pulp inflammation. Teeth with histologically diagnosed irreversible pulp inflammation were more likely to have lingering (OR 5.08; 95% CI 1.48-17.46, P = 0.010) and nocturnal tooth pain (OR 15.86; 95% CI 1.57-160.47, P = 0.019) when compared to teeth with reversible pulp inflammation. Using the classification and regression tree model, the presence of widened periodontal ligament space and nocturnal tooth pain were useful predictors of irreversible pulp inflammation with an accuracy of 78%.
CONCLUSION
The 2009 AAE criteria was acceptable for primary teeth with pulp necrosis and normal pulp but poor for reversible pulpitis and irreversible pulpitis.
Topics: Humans; Pulpitis; Dental Pulp Necrosis; Endodontists; Dental Pulp; Inflammation; Necrosis; Tooth, Deciduous; Pain
PubMed: 37624522
DOI: 10.1007/s00784-023-05217-6 -
Genes and Immunity Jun 2016The cost, prevalence and pain associated with endodontic disease necessitate an understanding of the fundamental molecular aspects of its pathogenesis. This study was...
The cost, prevalence and pain associated with endodontic disease necessitate an understanding of the fundamental molecular aspects of its pathogenesis. This study was aimed to identify the genetic contributors to pulpal pain and inflammation. Inflamed pulps were collected from patients diagnosed with irreversible pulpitis (n=20). Normal pulps from teeth extracted for various reasons served as controls (n=20). Pain level was assessed using a visual analog scale (VAS). Genome-wide microarray analysis was performed using Affymetrix GeneTitan Multichannel Instrument. The difference in gene expression levels were determined by the significance analysis of microarray program using a false discovery rate (q-value) of 5%. Genes involved in immune response, cytokine-cytokine receptor interaction and signaling, integrin cell surface interactions, and others were expressed at relatively higher levels in the pulpitis group. Moreover, several genes known to modulate pain and inflammation showed differential expression in asymptomatic and mild pain patients (⩾30 mm on VAS) compared with those with moderate to severe pain. This exploratory study provides a molecular basis for the clinical diagnosis of pulpitis. With an enhanced understanding of pulpal inflammation, future studies on treatment and management of pulpitis and on pain associated with it can have a biological reference to bridge treatment strategies with pulpal biology.
Topics: Adult; Case-Control Studies; Cytokines; Female; Gene Expression Profiling; Humans; Integrins; Male; Pulpitis; Receptors, Cytokine; Transcriptome
PubMed: 27052691
DOI: 10.1038/gene.2016.14