Referred pain is associated with greater odontogenic spontaneous pain and a heightened pain sensitivity in patients with symptomatic irreversible pulpitis.

BACKGROUND: Symptomatic irreversible pulpitis often results in heightened reactions to thermal stimuli such as pain evoked by a cold stimulus, and spontaneous odontogenic pain (unprovoked pain). OBJECTIVE: This study primarily compared the clinical manifestations of odontogenic spontaneous pain and pain provoked by cold stimulus specifically focusing on their sensory discriminative characteristics (intensity, duration and quality) between symptomatic irreversible pulpitis patients with and without referred pain. METHODS: Twenty-three patients with symptomatic irreversible pulpitis with referred pain and 12 patients without referred pain were included in this cross-sectional study. The following outcomes were assessed: odontogenic spontaneous pain and its descriptors; pain evoked by cold stimulus and qualitative sensory testing before and after local anaesthesia; referred pain location; use of analgesic medication; complementary anaesthesia efficacy. T-test, chi-squared and McNemar tests were applied to the data (p < .50). RESULTS: Patients with referred pain presented a greater odontogenic pain intensity (p < .05) when considered the average of the last 24 h. These patients also showed higher pain rating and pain descriptors (p < .05). Intensity and duration of the pain evoked by cold stimulus in the non-affected contralateral tooth at baseline were higher for patients with referred pain (p < .05). CONCLUSION: Symptomatic irreversible pulpitis patients with referred pain present greater odontogenic spontaneous pain and a heightened pain sensitivity. Therefore, patients with referred pain seem more complex from a pain severity perspective, supporting the clinical utility of discriminating symptomatic irreversible pulpitis with and without referred pain.

Association between Periodontitis and Myocardial Infarction: Systematic Review and Meta-Analysis

Abstract The association between periodontitis and myocardial infarction remains unclear in the literature. Few studies have addressed periodontitis exposure as a predisposing factor for the development of myocardial infarction. Therefore, the present systematic review aims to analyze the association between periodontitis and myocardial infarction. This meta-analysis systematically searched MEDLINE, EMBASE, The Cochrane Controlled Trials Register, SCIELO, LILACS, CINAHL, Scopus, Web of Science and grey literature for studies estimating the association between periodontitis and myocardial infarction. Quality of evidence was assessed for all studies. The meta-analysis was conducted using random-effects models. Four of the six studies selected were included in the meta-analysis, including 1,035,703 subjects. The association between periodontitis and myocardial infarction was: RR: 5.99 (95% CI: 1.17-30.68), but with high heterogeneity (I2 = 100%; p <0.01). The results including only the highest quality articles, was lower: RR: 2.62 (95% CI: 1.47-4.70 3.83), but with lower heterogeneity (I2 = 85.5%; p < 0.01).The present systematic review with meta-analysis showed an association between periodontitis and acute myocardial infarction, but with a high level of heterogeneity.

A randomized placebo-blind study of the effect of low power laser on pain caused by irreversible pulpitis.

This randomized placebo-blind study aimed to evaluate the effect of laser phototherapy (LPT) on pain caused by symptomatic irreversible pulpitis (SIP). Sixty patients diagnosed with SIP were randomly assigned to treatment groups (n = 15): G1 (control), G2 (laser placebo-sham irradiation), G3 (laser irradiation at 780 nm, 40 mW, 4 J/cm2), and G4 (laser irradiation at 780 nm, 40 mW, 40 J/cm2). Spontaneous pain was recorded using a VAS score before (T0), immediately after (T1), and 15 min after treatment (T2). Local anesthetics failure during emergency endodontic treatment was also assessed. There was no pain difference in T1 and T2 between the experimental laser groups (G3 and G4) and the placebo group (G2). The 4-J/cm2 (G3) irradiation resulted in significant increase in the local anesthetics failure in lower jar teeth. This effect could be suggested as consequence of the LPT improvement in local circulation and vasodilatation that would result in the increase of local anesthetic agent absorption. The application of 780-nm diode laser irradiation, at 4 and 40 J/cm2, showed no effect in reducing the pain in SIP in comparison to the placebo group. The fluence of 4 J/cm2 showed a negative effect in local anesthetics, resulting in significant increase of complimentary local anesthesia during emergency endodontic treatment. This work provides evidence of the consequence of LPT application on teeth with symptomatic irreversible pulpitis. LPT should be avoided in teeth with pain due to irreversible pulpitis.

Diabetes mellitus and inflammatory pulpal and periapical disease: a review.

Diabetes mellitus (DM) is one of the most common metabolic disorders. DM is characterized by hyperglycaemia, resulting in wound healing difficulties and systemic and oral manifestations, which have a direct effect on dental pulp integrity. Experimental and clinical studies have demonstrated a higher prevalence of periapical lesions in patients with uncontrolled diabetes. The influence of DM on periapical bone resorption and its impact on dental intervention of such patients are reviewed, and its aetiology and pathogenesis are analysed at molecular level. Pulps from patients with diabetes have the tendency to present limited dental collateral circulation, impaired immune response, increased risk of acquiring pulp infection (especially anaerobic ones) or necrosis, besides toothache and occasional tendency towards pulp necrosis caused by ischaemia. In regard to molecular pathology, hyperglycaemia is a stimulus for bone resorption, inhibiting osteoblastic differentiation and reducing bone recovery. The relationship between poorly controlled diabetes and bone metabolism is not clearly understood. Molecular knowledge about pulp alterations in patients with diabetes could offer new therapeutic directions. Knowledge about how diabetes affects systemic and oral health has an enduring importance, because it may imply not only systemic complications but also a higher risk of oral diseases with a significant effect on pulp and periapical tissue.

Lipopolysaccharide from Porphyromonas gingivalis sensitizes capsaicin-sensitive nociceptors.

Although odontogenic infections are often accompanied by pain, little is known about the potential mechanisms mediating this effect. In this study we tested the hypothesis that trigeminal nociceptive neurons are directly sensitized by lipopolysaccharide (LPS) isolated from an endodontic pathogen, Porphyromonas gingivalis. In vitro studies conducted with cultures of rat trigeminal neurons demonstrated that pretreatment with LPS produced a significant increase in the capsaicin-evoked release of calcitonin gene-related peptide (CGRP) when compared with vehicle pretreatment, thus showing sensitization of the capsaicin receptor, TRPV1, by LPS. Furthermore, confocal microscopic examination of human tooth pulp samples showed the colocalization of the LPS receptor (toll-like receptor 4, TLR4) with CGRP-containing nerve fibers. Collectively, these results suggest the direct sensitization of nociceptors by LPS at concentrations found in infected canal systems as one mechanism responsible for the pain associated with bacterial infections.

Fístula odontogénica / Odontogenic cutaneous sinus tract

La fistula odontogénica es una patología que se expresa habitualmente como un nódulo crónico con episodios de superación intermitente localizado en cara. Su sospecha clínica permitirá su diagnóstico. La detección y el tratamiento de la causa que la originó resolverá el cuadro. Se presenta una paciente con fistula odontogénica de cinco meses de evolución al momento de la consulta dermatológica, en quien un correcto examen de su cavidad bucal permitió diagnosticar y tratar el absceso dentoalveolar que la había originado con resolución del cuadro

Fístula odontogénica / Odontogenic cutaneous sinus tract

La fistula odontogénica es una patología que se expresa habitualmente como un nódulo crónico con episodios de superación intermitente localizado en cara. Su sospecha clínica permitirá su diagnóstico. La detección y el tratamiento de la causa que la originó resolverá el cuadro. Se presenta una paciente con fistula odontogénica de cinco meses de evolución al momento de la consulta dermatológica, en quien un correcto examen de su cavidad bucal permitió diagnosticar y tratar el absceso dentoalveolar que la había originado con resolución del cuadro (AU)

Endodontic management of a mandibular third molar fused with a fourth molar.

CASE REPORT: Developmental anomalies in permanent molars frequently require surgical intervention. A case of a mandibular third molar fused with a fourth molar which was successfully treated with conservative endodontic therapy is reported.

Dificuldades no diagnóstico diferencial de dores dentárias referidas à face: conduta clínica e consideraçöes sobre uma amostra / Difficulties in the differential diagnosis of the referred dental pain to face: considerations about a clinical sample

Säo apresentados e discutidos 5 relatos de casos clínicos de pacientes com dor referida craniofacial de causa dentária. Esses pacientes, embora atendidos inicialmente por dentistas foram encaminhados a especialistas para tratamento de desordem temporomandibular com o uso de placas de mordida ou a neurologistas para o tratamento de nevralgias ou de dor facial atípica, até serem definitivamente diagnosticados como portadores de patologia dentária. O diagnóstico final foi: periodontite apical aguda (2) e pulpite irreversível (3). A idade variou de 35 a 60 anos (média de 45) e a duraçäo da dor e dos tratamentos anteriores variou de 10 a 60 dias. Possivelmente o trauma oclusal foi um fator etiológico importante em 3 mulheres. Na quarta paciente a presença de um trauma mandibular e parestesia do lábio confundiram o diagnóstico de pulpite do 35. O único homem da amostra apresentava cárie subgengival do 43. É necessário conhecer os critérios para o diagnóstico diferencial e a aplicaçäo de métodos terapêuticos que sirvam de testes para ajudar no diagnóstico. Ter cautela antes de procedimentos invasivos, como extraçöes dentárias, que podem ser iatrogênicos ou fontes adicionais de dor, confundindo mais o quadro clínico e favorecendo a cronicidade em pacientes susceptíveis e, finalmente, estabelecer um protocolo de atendimento como estratégia para diagnóstico e controle da dor em casos considerados difíceis

Endodontic therapy and root submersion of an impacted maxillary canine. A case report and review of the root submergence concept.

A case report of root submersion of a maxillary canine after endodontic therapy is presented. A review of the rationale and validity of the root submersion concept is also presented.

Abscessos dentoalveolares agudos y su tratamiento con Hepar sulphur y Silicea terra / Acute dentoalveolar abscess and its treatment with Hepar sulphur and Silicea terra

Los abscesos dentoalveolares son una consecuencia de la infeccion pulpar. Se sabe que la enfermedad pulpar es una enfermedad muy comun en la consulta odontologica, practicamente un 70% de los pacientes que acuden a consulta, presentan este problema. La infeccion localizada en esta area es comun y frecuentemente se convierte en un foco a partir del cual la infeccion se disemina a otras partes del organismo. La Terapeutica Homeopatica es de gran ayuda, por las caracteristicas tan especificas de esta forma de tratamiento; ademas el uso de estos medicamentos, evita problemas como el "sensibilizar" y provocar trastornos alergicos, que incluso pueden llegar el choque anafilactico

Abscessos dentoalveolares agudos y su tratamiento con Hepar sulphur y Silicea terra / Acute dentoalveolar abscess and its treatment with Hepar sulphur and Silicea terra

Los abscesos dentoalveolares son una consecuencia de la infeccion pulpar. Se sabe que la enfermedad pulpar es una enfermedad muy comun en la consulta odontologica, practicamente un 70 porcento de los pacientes que acuden a consulta, presentan este problema. La infeccion localizada en esta area es comun y frecuentemente se convierte en un foco a partir del cual la infeccion se disemina a otras partes del organismo. La Terapeutica Homeopatica es de gran ayuda, por las caracteristicas tan especificas de esta forma de tratamiento; ademas el uso de estos medicamentos, evita problemas como el "sensibilizar" y provocar trastornos alergicos, que incluso pueden llegar el choque anafilactico