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American Journal of Otolaryngology 2021Endodontic disease is one of the most common causes of bacterial odontogenic sinusitis (ODS). Diagnosing ODS of endodontic origin involves otolaryngologists confirming... (Review)
Review
PURPOSE
Endodontic disease is one of the most common causes of bacterial odontogenic sinusitis (ODS). Diagnosing ODS of endodontic origin involves otolaryngologists confirming sinusitis, and dental specialists confirming endodontic sources. The purpose of this study was to conduct a multidisciplinary literature review to highlight clinical and microbiological features of ODS, and the most optimal diagnostic modalities to confirm endodontic disease.
METHODS
An extensive review of both medical and dental literature was performed by rhinologists, endodontists, and an infectious disease specialist. Frequencies of various clinical and microbiological features from ODS studies were collected, and averages were calculated. Different endodontic testing and imaging modalities were also evaluated on their abilities to confirm endodontic disease.
RESULTS
ODS patients most often present with unilateral sinonasal symptoms for over 3 months, purulence on nasal endoscopy, and overt dental pathology on computed tomography (CT). Subjective foul smell, and maxillary sinus cultures demonstrating anaerobes and α-streptococci (viridans group) may be more specific to ODS. For endodontic evaluations, cold pulp testing and cone-beam CT imaging are most optimal for confirming pulpal and periapical disease.
CONCLUSION
Diagnosing ODS requires collaboration between otolaryngologists and dental specialists. Clinicians should suspect ODS when patients present with unilateral sinonasal symptoms, especially foul smell. Patients will generally have purulent drainage on nasal endoscopy, and both sinus opacification and overt dental pathology on CT. However, some patients will have subtle or absent dental pathology on CT. For suspected endodontic disease, endodontists should be consulted for at least cold pulp testing, and ideally cone-beam CT.
Topics: Adult; Bacterial Infections; Cone-Beam Computed Tomography; Female; Humans; Male; Maxillary Sinusitis; Middle Aged; Pulpitis; Tomography, X-Ray Computed; Viridans Streptococci
PubMed: 33486208
DOI: 10.1016/j.amjoto.2021.102925 -
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 -
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 -
International Endodontic Journal Feb 2023To evaluate the expression and function of the nod-like receptor pyrin domain containing 3 (NLRP3) inflammasome in caries induced pulpitis.
AIM
To evaluate the expression and function of the nod-like receptor pyrin domain containing 3 (NLRP3) inflammasome in caries induced pulpitis.
METHODOLOGY
NLRP3 expression was determined with immunohistochemistry in the dental pulp and qPCR in dental pulp cells (DPCs). THP-1 macrophages expressing the apoptosis-related speck-like protein (ASC) and green fluorescent protein (GFP) fusion protein were used to assess NLRP3 inflammasome activation by live cell imaging, following treatment with lipopolysaccharide (LPS) and lipoteichoic acid (LTA). Caspase I inhibitor was used to confirm inflammasome activation. An ex-vivo pulpitis model in which the DPCs were co-cultured with THP-1 macrophages was used to study the effect of the NLRP3 inflammasome inhibitor (MCC950), and cytokines were measured using ELISA and multiplex array. Data were analysed using the t-test or anova followed by a Bonferroni post hoc test with the level of significance set at p ≤ .05.
RESULTS
NLRP3 inflammasome was differentially expressed in dental pulp of sound and carious teeth. Treatment of DPCs with LTA significantly upregulates NLRP3 and IL-1 β-expression (p < .05) and in induces more ASC specks formation compared to LPS. IL-β release in response to LTA treatment is significantly reduced with Caspase I inhibitor suggesting inflammasome dependent mechanism (p < .01). NLRP3-specific inhibitor, MCC950, significantly reduced IL-1β and IL-6 in an ex-vivo pulpitis model (p < .01) but had no effect on IL-8 or matrix metalloproteinase-9 (MMP-9).
CONCLUSIONS
Expression and upregulation of NLRP3 inflammasome with caries and LTA treatment suggest a role in caries-induced pulpitis. NLRP3 inhibitor attenuated the release of selective inflammatory cytokines and could be a potential treatment target that merit further investigation.
Topics: Humans; Inflammasomes; NLR Family, Pyrin Domain-Containing 3 Protein; Lipopolysaccharides; Pulpitis; Dental Caries Susceptibility; Inflammation; Sulfonamides; Caspases; Cytokines; Interleukin-1beta
PubMed: 36287083
DOI: 10.1111/iej.13855 -
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 Endodontic Journal Aug 2024The European Society of Endodontology published in 2023, the S3-level clinical practice guidelines, which supersede the Quality Guidelines for Endodontic Treatment... (Review)
Review
BACKGROUND
The European Society of Endodontology published in 2023, the S3-level clinical practice guidelines, which supersede the Quality Guidelines for Endodontic Treatment published in 2006.
OBJECTIVES
This review aims to summarize and compare the above guidelines to support their dissemination.
METHOD
A narrative synthesis of the main differences alongside tabulation according to the main themes.
RESULTS
Three tables were prepared according to the following themes: diagnosis of pulpal and apical condition; treatment of pulpitis; and treatment of nonvital pulp and apical periodontitis.
CONCLUSIONS
A compared and simplified message regarding the most recent clinical practice guidelines has been prepared.
REGISTRATION
Not applicable as a narrative review.
Topics: Humans; Endodontics; Europe; Practice Guidelines as Topic; Societies, Dental; Periapical Periodontitis; Pulpitis
PubMed: 38523348
DOI: 10.1111/iej.14067 -
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 -
Journal of Endodontics Apr 2023Accurate diagnosis is one of the most important steps before endodontic treatment. The aim of this study was to assess the effect of 2 commonly used analgesics namely... (Clinical Trial)
Clinical Trial
INTRODUCTION
Accurate diagnosis is one of the most important steps before endodontic treatment. The aim of this study was to assess the effect of 2 commonly used analgesics namely ibuprofen and acetaminophen on the cold and electric pulp test (EPT) results in participants with symptomatic irreversible pulpitis (SIP).
METHODS
This clinical trial evaluated 41 participants with pain due to SIP. The cold test and EPT were performed for teeth with SIP, and also for the corresponding tooth with healthy pulp in the contralateral quadrant. The participants then received 500 mg acetaminophen, 400 mg ibuprofen, or the placebo in the 3 groups. The cold test and EPT were repeated at 20, 40, and 60 minutes after medication intake, and the results were compared with the pretreatment values.
RESULTS
In the acetaminophen group, the results of cold test significantly decreased 40 (P < .05), and 60 (P < .05) minutes after analgesic intake in teeth with SIP and after 40 minutes (P < .05) in the corresponding contralateral teeth with healthy pulp. In the ibuprofen group, the cold test results significantly decreased at 20 (P < .05), 40 (P < .05), and 60 (P < .05) minutes after analgesic intake in teeth with SIP and after 40 minutes (P < .05) in the corresponding contralateral teeth with healthy pulp. The EPT results were not significantly affected by the studied analgesics at any time point (P > .05). There was no significant difference among the study groups regarding sex (P > .05).
CONCLUSION
It appears that both acetaminophen and ibuprofen can affect the pulpal response to the cold sensibility test. However, the studied medications had no significant effect on the EPT results. Therefore, dental clinicians should be aware of the possible effects of such medications on the cold test response.
Topics: Humans; Acetaminophen; Analgesics; Dental Pulp; Ibuprofen; Pulpitis
PubMed: 36657522
DOI: 10.1016/j.joen.2023.01.003 -
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 -
Oral Diseases May 2022Our study aimed to observe the distribution of putative stem cells in irreversible pulpitis and to investigate the expression of specific molecules.
OBJECTIVES
Our study aimed to observe the distribution of putative stem cells in irreversible pulpitis and to investigate the expression of specific molecules.
SUBJECTS AND METHODS
Extracted third molar teeth were collected and divided into two groups: the normal pulp group and inflamed pulp group. Real-time PCR was applied to detect the expression of several embryonic and dentinogenic genes. The expression of mesenchymal cell markers (STRO-1, CD90, and CD146) and stromal cell-derived factor 1α (SDF-1α)/CXC chemokine receptor 4 (CXCR4) proteins was examined by immunohistochemical analysis.
RESULTS
The expression levels of most embryonic and dentinogenic genes were not statistically different between the two groups. Immunohistochemical analysis revealed that in inflamed pulp, cells with positive expression for STRO-1, CD90, and CD146 mainly resided in two specific niches, both adjacent to inflammatory sites: one in the pulp core and another in the odontoblast layer. SDF-1α- and CXCR4-positive cells were significantly correlated with STRO-1-positive cells. Double immunofluorescence analysis indicated that STRO-1-positive cells overlapped with SDF-1α- and CXCR4-positive cells near the inflammatory site.
CONCLUSIONS
This study gave a direct observation of putative stem cells distributed in irreversible pulpitis and implied a role of SDF-1α/CXCR4 signaling in stem cell-based therapies for reparative dentinogenesis.
Topics: CD146 Antigen; Chemokine CXCL12; Dental Pulp; Humans; Pulpitis; Receptors, CXCR4; Stem Cells
PubMed: 33728761
DOI: 10.1111/odi.13850