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Scientific Reports Jan 2016Clinically, irreversible pulpitis is treated by the complete removal of pulp tissue followed by replacement with artificial materials. There is considered to be a high...
Clinically, irreversible pulpitis is treated by the complete removal of pulp tissue followed by replacement with artificial materials. There is considered to be a high potential for autologous transplantation of human dental pulp stem cells (DPSCs) in endodontic treatment. The usefulness of DPSCs isolated from healthy teeth is limited. However, DPSCs isolated from diseased teeth with irreversible pulpitis (IP-DPSCs) are considered to be suitable for dentin/pulp regeneration. In this study, we examined the stem cell potency of IP-DPSCs. In comparison with healthy DPSCs, IP-DPSCs expressed lower colony-forming capacity, population-doubling rate, cell proliferation, multipotency, in vivo dentin regeneration, and immunosuppressive activity, suggesting that intact IP-DPSCs may be inadequate for dentin/pulp regeneration. Therefore, we attempted to improve the impaired in vivo dentin regeneration and in vitro immunosuppressive functions of IP-DPSCs to enable dentin/pulp regeneration. Interferon gamma (IFN-γ) treatment enhanced in vivo dentin regeneration and in vitro T cell suppression of IP-DPSCs, whereas treatment with tumor necrosis factor alpha did not. Therefore, these findings suggest that IFN-γ may be a feasible modulator to improve the functions of impaired IP-DPSCs, suggesting that autologous transplantation of IFN-γ-accelerated IP-DPSCs might be a promising new therapeutic strategy for dentin/pulp tissue engineering in future endodontic treatment.
Topics: Adult; Animals; Biomarkers; Cell Proliferation; Cell Self Renewal; Cell Survival; Dental Pulp; Female; Humans; Immunomodulation; Immunophenotyping; Interferon-gamma; Mice; Phenotype; Pulpitis; Regeneration; Stem Cells; Young Adult
PubMed: 26775677
DOI: 10.1038/srep19286 -
Equine Veterinary Journal Sep 2015The most prevalent type of equine dental pulpitis due to apical infection is not associated with coronal fractures or periodontal disease. The pathogenesis of this type...
REASONS FOR PERFORMING STUDY
The most prevalent type of equine dental pulpitis due to apical infection is not associated with coronal fractures or periodontal disease. The pathogenesis of this type of pulpitis is not fully understood. Computed tomography (CT) is increasingly used to investigate equine dental disorders. However, gross, tomographic and histopathological changes in equine dental pulpitis have not been compared previously.
OBJECTIVES
To compare gross, CT and histological appearances of sectioned mandibular cheek teeth extracted from horses with clinical signs of pulpitis without coronal fractures or periodontal disease. To contribute to understanding the pathogenesis of equine dental pulpitis.
STUDY DESIGN
Descriptive study using diseased and healthy teeth.
METHODS
Mandibular cheek teeth extracted from horses with clinical signs of pulpitis (cases), and from cadavers with no history of dental disease (controls), were compared using CT in the transverse plane at 1 mm intervals. Teeth were then sectioned transversely, photographed and processed for histopathological examination. Tomographs were compared with corresponding gross and histological sections.
RESULTS
Cement, dentine and bone had similar ranges of attenuation (550-2000 Hounsfield Units, HU) in tomographs but could be differentiated from pulp (-400 to 500 HU) and enamel (> 2500 HU). Twelve discrete dental lesions were identified grossly, 10 of which were characterised histologically. Reactive and reparative dentinogenesis and extensive pulpar mineralisation, previously undescribed, were identified. Pulpar oedema, neutrophilic inflammation, cement and enamel defects, and reactive cemental deposition were also observed. The CT and pathological findings corresponded well where there was mineralised tissue deposited, defects in mineralised tissue, or food material in the pulpar area. Pulpar and dentinal necrosis and cement destruction, evident grossly and histologically, did not correspond to CT changes.
CONCLUSIONS
Computed tomography is useful for identifying deposition and defects of mineralised material but less useful for identifying inflammation and tissue destruction. The equine dentine-pulp complex responds to insult with reactive and reparative changes.
Topics: Animals; Case-Control Studies; Horse Diseases; Horses; Pulpitis; Tomography, X-Ray Computed; Tooth; Tooth Extraction
PubMed: 24975383
DOI: 10.1111/evj.12315 -
International Endodontic Journal Jan 2003The purpose of this histological study was to examine teeth with hyperplastic pulpitis caused by trauma or caries.
AIM
The purpose of this histological study was to examine teeth with hyperplastic pulpitis caused by trauma or caries.
SUMMARY
The pulp tissue of one young permanent incisor with a complicated crown-root fracture and a hyperplastic pulpitis, which had been contaminated with oral microflora for 40 days, and pulp polyps from four permanent first molars whose crowns were destroyed by extensive caries were prepared for standard histological examination. Histologically, normal pulp tissue organization was observed in the tooth with a complicated crown-root fracture in the cervical radicular region. Irregular calcification was seen in the coronal and radicular portion of the pulp in the four carious teeth with pulp polyps. Radicular pulp tissue in the middle and apical third of root canals beneath irregular calcification showed intensive fibrosis but was free from inflammatory cells.
KEY LEARNING POINTS
Hyperplastic pulpitis is a type of irreversible chronic open pulpitis. Young permanent teeth with hyperplastic pulpitis caused by trauma or caries have a great inherent defensive capacity to heal.
Topics: Adolescent; Adult; Child; Dental Caries; Dental Pulp Exposure; Humans; Hyperplasia; Incisor; Pulpitis; Tooth Fractures
PubMed: 12656516
DOI: 10.1046/j.1365-2591.2003.00590.x -
East African Medical Journal Dec 1996Pulpalgia is strong and often throbbing and it can start and stop spontaneously. When evoked, pain in pulpitis outlasts the stimulus. The pain is difficult to localise... (Review)
Review
Pulpalgia is strong and often throbbing and it can start and stop spontaneously. When evoked, pain in pulpitis outlasts the stimulus. The pain is difficult to localise and often radiates to other parts of the face. But the pain symptoms vary. There are cases of severe pulpitis progressing to abscess formation and even necrosis without any symptoms (silent pulpitis). In some cases slight pulpal inflammatory changes will cause severe pain. It seems that correlation between clinical symptoms and histopathological condition of the pulp is not clear. Pulpal inflammatory changes may cause hypersensitivity of the intradental nerves. Vasodilation, increased vascular permeability and extravasation will cause increased intrapulpal pressure. This could spontaneously activate the pulpal nerves. The increased pressure will selectively activate the C-fibres while blocking the A-fibres which are more vulnerable to hypoxia. This would explain the change in pain symptoms during progress of pulpitis to dull type of pain. Some of the inflammatory mediators can excite the pulpal nerves while others even have an analgesic effect. Some of the exogenous compounds (bacterial metabolites and substances released during the breakdown of dentine) induce nerve activity in the pulp while others have a depressing effect. The net effect will probably depend on the relative proportions and concentrations of these substances in the pulp. This would also explain the variability of pain symptoms in pulpitis. Also the condition of dentine with blocked or patent dentinal tubules is important. If the substances with depressive effect are predominantly in greater proportions and concentrations, and if the dentinal tubules are blocked, this could be the case of "silent pulpitis".
Topics: Dentin; Humans; Nerve Fibers; Nerve Fibers, Myelinated; Pain; Pain Measurement; Pulpitis; Severity of Illness Index
PubMed: 9103684
DOI: No ID Found -
International Endodontic Journal Apr 2024To investigate patient outcomes from either pulpotomy or pulpectomy for the management of symptomatic irreversible pulpitis, with and without application of...
AIM
To investigate patient outcomes from either pulpotomy or pulpectomy for the management of symptomatic irreversible pulpitis, with and without application of antibiotic/corticosteroid pastes in urgent primary dental care settings in the United Kingdom.
METHODOLOGY
All patients receiving intervention for symptomatic irreversible pulpitis in three different primary care settings were invited to participate. Pre-operatively, data regarding patients' numerical ratings scale (NRS), pain score (0-10), analgesic use, oral-health impact profile-14 (OHIP-14) and need for time away from work were collected. For 7 days post-operatively, participants recorded their NRS pain score, global rating of change score, medication use and their ability to work. Analysis used a mixed-effects model with post hoc Tukey's multiple comparisons test for continuous data and chi-squared or Fisher's exact test for categorical data. To test the effect of the corticosteroid/antibiotic paste, pulpectomy and pulpotomy groups were combined following Mantel-Haenszel stratified analysis or a weighted average of the difference between pulpotomy and pulpectomy with and without the use of corticosteroid/antibiotic paste. A binary composite score was constructed using pre- and post-operative data, whereby overall treatment success was defined as: (i) patients did not return for treatment due to pain by day seven; (ii) at day three, there was a 33% (or 2-points) reduction in NRS pain score; (iii) there was a change score of +3 in global rating; (iv) the patient was no longer using analgesia and able to return to work.
RESULTS
Eighty-five participants were recruited, with 83 completing follow up. Overall treatment success was 57%, with 25% of participants returning for more treatment due to inadequate pain relief. Overall treatment success did not differ between the two groups (p = .645), although patients self-reported greater improvement with an antibiotic/corticosteroid dressing for global rating of change (p = .015).
CONCLUSIONS
This study identified limited evidence of improved outcomes using antibiotic/corticosteroid dressings in the management of symptomatic irreversible pulpitis in the emergency setting. Further clinical research is needed to understand if these medications are beneficial in affording pain relief, above that of simple excision of irreversibly inflamed pulp tissue.
Topics: Humans; Pulpitis; Cohort Studies; Pulpotomy; Pain; Adrenal Cortex Hormones; Anti-Bacterial Agents
PubMed: 38214015
DOI: 10.1111/iej.14020 -
Journal of the Formosan Medical... Jun 2018Trigeminocardiac reflex (TCR) is a unique clinical incident of acute change in hemodynamic balance, which may lead to hypotension, bradycardia, and even clinical crisis....
BACKGROUND/PURPOSE
Trigeminocardiac reflex (TCR) is a unique clinical incident of acute change in hemodynamic balance, which may lead to hypotension, bradycardia, and even clinical crisis. Up to date, no study so far considers the impact of non-surgical root canal treatment (NSRCT) of irreversible pulpitis teeth under either local infiltration or block anesthesia on hemodynamic change possibly related to TCR.
METHODS
This study enrolled 111 patients with 138 irreversible pulpitis teeth that were treated by two sessions of NSRCT. The first session involved mainly the removal of vital pulp tissue with the direct stimulation of the dental branches of the trigeminal nerve, and the second session included the root canal enlargement and debridement with minimal disturbance to the dental branches of the trigeminal nerve. Vital signs mainly the blood pressure were recorded during both NSRCT sessions.
RESULTS
The incidences of NSRCT patients with MABP decrease ≧10%, ≧15%, or ≧20% were all significantly higher in the first NSRCT session than in the second NSRCT session (all the P-values < 0.001). In the first NSRCT session, the incidence of patients with MABP decrease ≧10% was significantly associated with tooth type. For both upper and lower teeth, the patients with premolars treated by NSRCR had significantly higher incidences of MABP decrease ≧10% than those with either anterior or molar teeth treated by NSRCR (all the P-values < 0.05).
CONCLUSION
We conclude that vital pulp extirpation may lead to a substantial drop in patient's blood pressure possibly related to TCR.
Topics: Adult; Aged; Blood Pressure; Female; Humans; Male; Middle Aged; Pulpitis; Reflex, Trigeminocardiac; Root Canal Therapy; Taiwan; Trigeminal Nerve; Young Adult
PubMed: 28728750
DOI: 10.1016/j.jfma.2017.05.010 -
BMC Oral Health May 2024Pulpectomy continues to be the standard treatment recommendation for management of vital primary molars diagnosed with symptomatic irreversible pulpitis. The recent... (Randomized Controlled Trial)
Randomized Controlled Trial Comparative Study
Treatment outcomes of pulpotomy versus pulpectomy in vital primary molars diagnosed with symptomatic irreversible pulpitis: protocol for a non-inferiority randomised controlled trial.
BACKGROUND
Pulpectomy continues to be the standard treatment recommendation for management of vital primary molars diagnosed with symptomatic irreversible pulpitis. The recent decade has seen a paradigm shift in the treatment concepts of how vital mature permanent molars diagnosed with irreversible pulpitis can be more conservatively managed using vital pulp therapy techniques like pulpotomy. However, despite emerging evidence indicating similarities between primary and permanent tooth pulp response to dental caries, there is limited research on whether pulpotomy can be similarly used as a definitive treatment modality for vital primary teeth with irreversible pulpitis. This randomised controlled trial (RCT) aims to compare the treatment effectiveness of pulpotomy versus pulpectomy in management of vital primary molars diagnosed with symptomatic irreversible pulpitis over a two-year period.
METHODS/DESIGN
This clinical study is a parallel, two-armed, open label, non-inferiority RCT with a 1:1 allocation ratio between the experimental intervention arm (pulpotomy) and the active comparator arm (pulpectomy). Healthy cooperative children, between 4-9 years of age, who have painful primary molars with clinical symptoms typical of irreversible pulpitis will be recruited after obtaining informed consent from their parents/legal guardians. 50 vital primary molars clinically diagnosed with symptomatic irreversible pulpitis will be randomly distributed between the two treatment arms. The primary outcomes that will be assessed are clinical and radiographic success after six-months, one-year and two-years of the trial interventions. The influence of baseline pre-operative variables (age; gender; tooth type; site of caries; pre-operative furcal radiolucency; pre-operative pain intensity) and intra-operative factors (time taken to achieve haemostasis) on treatment outcomes will also be assessed. The secondary outcome evaluated will be the immediate (24 h and 7 d) post-operative pain relief afforded by the two treatment interventions.
DISCUSSION
This trial seeks to provide evidence on whether pulpotomy treatment can be no worse than the standard pulpectomy treatment for the management of symptomatic irreversible pulpitis in vital primary molars.
TRIAL REGISTRATION
ClinicalTrials.gov (NCT06183203). Registered on 30 January 2024.
Topics: Humans; Pulpotomy; Pulpectomy; Pulpitis; Tooth, Deciduous; Molar; Child; Child, Preschool; Treatment Outcome; Equivalence Trials as Topic; Female; Male
PubMed: 38807160
DOI: 10.1186/s12903-024-04411-6 -
Journal of Pain & Palliative Care... 2006Nitric oxide (NO) affects both pain and inflammation in human tissues. Pharmacotherapy that decreases NO concentrations may have utility in treating inflammatory painful...
Nitric oxide (NO) affects both pain and inflammation in human tissues. Pharmacotherapy that decreases NO concentrations may have utility in treating inflammatory painful conditions. To determine the types of disorders in which such an approach should be studied, changes in NO serum levels before and after the painful inflammatory condition resolves would be helpful. This study compared the pre-treatment and post-treatment serum nitric oxide (NO) concentrations in irreversible pulpitis (inflammatory toothache). Thirty-two patients (16 males, 16 females) with irreversible pulpitis were included in this study. Before treatment, patients had severe symptoms of inflammation, but at the end of treatment no symptoms of inflammation were observed. NO concentrations were measured in serum of patients with irreversible pulpitis, before and after treatment. Differences in serum NO concentrations were not statistically significantly different before and after treatment.
Topics: Adolescent; Adult; Female; Humans; Male; Nitric Oxide; Pulpitis
PubMed: 16687351
DOI: 10.1080/j354v20n01_04 -
American Family Physician Mar 2008Family physicians commonly encounter patients with dental infections, such as dental caries and periodontal disease. Dental caries is caused by bacteria that destroy the... (Review)
Review
Family physicians commonly encounter patients with dental infections, such as dental caries and periodontal disease. Dental caries is caused by bacteria that destroy the enamel and dentin; it can be detected by an oral examination that shows stained pits or fissures on the tooth surface. Use of fluoride is the most effective prevention measure for dental caries. Untreated caries may progress to pulpitis and, eventually, to necrosis of the pulp. In irreversible pulpitis, the tooth dies and the patient may have a localized abscess that can spread to surrounding tissue. Periodontal infections are caused by bacteria in the subgingival dental plaque. In gingivitis, the inflamed gums bleed easily with brushing or flossing; the condition can be controlled with good oral hygiene. Periodontitis is characterized by a loss of supportive bone structure caused by chronic gingivitis; it is also associated with some systemic diseases. Localized periodontitis is treated with mechanical debridement and good oral hygiene, whereas generalized periodontitis requires adjunct antibiotic therapy. Pericoronitis results when food particles become trapped under the gum of an impacted tooth. This condition can be controlled by removal of food debris and good oral hygiene. For patients in whom dental infections are disseminated and have invaded the deeper oral spaces, antibiotic treatment should be initiated at the time of referral.
Topics: Dental Caries; Humans; Periodontal Diseases; Primary Health Care; Pulpitis
PubMed: 18386594
DOI: No ID Found -
Equine Veterinary Journal Jan 2010With the advent of detailed oral examination in horses using dental mirrors and rigid endoscopy, secondary dentinal lesions are observed more frequently. More...
REASONS FOR PERFORMING STUDY
With the advent of detailed oral examination in horses using dental mirrors and rigid endoscopy, secondary dentinal lesions are observed more frequently. More information regarding the association of secondary dentinal defects with apical dental disease would improve the sensitivity of oral examination as a diagnostic aid for pulpitis.
OBJECTIVES
To assess prevalence and severity of secondary dentinal defects observed on examination of occlusal surfaces of cheek teeth (CT) from horses showing clinical signs of pulpitis compared to asymptomatic controls.
METHODS
Records from all cases of equine CT exodontia at the University of Bristol over a 4 year period were examined. Case selection criteria included the presence of clinical signs of pulpitis, an intact extracted tooth and availability of a complete history and follow up. Cases where coronal fracture or periodontal pocketing featured were excluded. CT from cadavers with no history of dental disease served as normal controls. Triadan positions and eruption ages of control teeth were matched with those of teeth extracted from cases. CT from selected cases and control teeth were examined occlusally. Secondary dentinal defects were identified and graded. Prevalence of occlusal lesions in CT with pulpitis and controls was compared.
RESULTS
From the records of 120 horses where exodontia was performed, 40 cases matched selection criteria. Twenty-three mandibular and 21 maxillary CT were extracted from cases. The controls consisted of 60 mandibular and 60 maxillary CT from 7 cadaver skulls. Secondary dentinal defects were significantly over-represented in CT extracted from cases of pulpitis (P < 0.001). Of diseased mandibular CT, 56.5% had defects compared to none of the controls. Of diseased maxillary CT, 57% had defects compared with 1.6% of controls. Multiple defective secondary dentinal areas and severe lesions were more prevalent in diseased mandibular CT compared with diseased maxillary CT. CONCLUSIONS AND PRACTICAL SIGNIFICANCE: Careful examination of occlusal secondary dentine is an essential component in investigation of suspected pulpitis in equine CT.
Topics: Animals; Dentistry; Horse Diseases; Horses; Pulpitis; Tooth
PubMed: 20121910
DOI: 10.2746/042516409X464104