The use of medicaments in the management of symptomatic irreversible pulpitis: A community-based cohort study.

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.

The financial and quality of life impact of urgent dental presentations: A cross-sectional study.

AIM: This study aimed to: (i) calculate personal financial costs associated with urgent dental attendance; and (ii) investigate the pain-related disability and quality of life impact of dental conditions which result in urgent dental attendance. METHODOLOGY: Data were collected from those presenting with urgent dental conditions to an out-of-hours dental service, a dental emergency clinic (DEC) and five primary care general dental practices across North-East England. A pre-operative questionnaire explored the impact of urgent dental conditions on oral health-related quality of life (OHRQoL) using Oral Health Impact Profile-14 (OHIP-14) and a modified Graded Chronic Pain Scale (GCPS). OHIP-14 yields a maximum score of 56, with a higher score indicating a lower OHRQoL. Personal financial costs were summed to provide a total. These included travel, appointment fees, childcare costs, medication use and time away from work. Data were analysed using one-way anova and multivariable modelling. RESULTS: In total, 714 participants were recruited. The mean OHIP-14 score was 25.73; 95% CI [24.67, 26.79], GCPS CPI was 71.69; 95% CI [70.09, 73.28] and GCPS interference was 49.56; 95% CI [47.24, 51.87]. Symptomatic irreversible pulpitis was the most frequently managed dental emergency and was associated with the highest mean OHIP-14 score (31.67; 95% CI [30.20, 33.15]). The mean personal financial cost of urgent dental care (UDC) was £85.81; 95% CI [73.29, 98.33]. Differences in travel time (F[2, 691] = 10.24, p < .001), transport costs (F[2, 698] = 4.92, p = .004), and appointment time (F[2, 74] = 9.40, p < .001) were significant between patients attending an out-of-hours dental service, DEC and dental practices for emergency care, with a DEC being associated with the highest costs and dental practices the lowest. CONCLUSIONS: Diseases of the pulp and associated periapical disease were the most common reason for patients to present for UDC and were the most impactful in terms of OHRQoL and pain in the present sample. Personal financial costs are significant from urgent dental conditions, with centralized services increasing the burden to patients of attending appointments.

Endodontic procedures produce bacterial droplet contamination - but what about viruses?

Research question The study aims to investigate spread, distance and spatial distribution of aerosolised microorganisms generated through various endodontic procedures.Study design A case-control study carried out at the University of Maryland, US in 2020. The study investigated the aerosolised microorganisms produced during three endodontic treatments: emergency pulpotomy, emergency pulpectomy and non-surgical root canal therapy (NSRCT), with 15 participants in each group (n = 45). Patients diagnosed with symptomatic apical periodontitis were included. The use of settle plates for passive air sampling was employed, in a 4 x 4 m room with closed doors. The number of colony-forming units (CFUs) and composition of bacterial species were analysed. Variables within the study included: distance of plate to patient's mouth (0.5 m or 2 m), positioning of plate (directly in front of or diagonal to the participant's mouth), type of endodontic treatment performed and the duration of treatment. A baseline sample was collected (room at rest) as a control. All dental treatment was carried out under rubber dam, after patients had undergone a pre-operative 0.12% chlorhexidine digluconate mouth rinse for 60 seconds. An extraoral suction system (ADS EOS Dental System Inc; Ontario, CA, USA) was also placed directly in front of the patient's mouth throughout treatment.Results A significantly greater number of CFUs were recorded after endodontic treatments (all treatments), compared to negative control. CFUs were lower in the emergency pulpotomy group compared to the other two groups. There was a significantly lower number of CFUs found at plates situated 0.5 m, compared to 2 m, away from the patient. There was a positive correlation between the procedure duration and CFU count. The main bacterial species detected were Staphylococcus aureus (48.8%), Staphlococcus epidermidis (42.2%) and oral streptococci (33.1%). Pseudomonas aeruginosa and fungi were not detected.Conclusion Emergency pulpectomy and NSRCT created greater microbial contamination than an emergency pulpotomy. Greater numbers of microorganisms were found after longer treatment times and closer to the patient's mouth.