Altered Prevalence of Pulp Diagnoses in Diabetes Mellitus Patients: A Retrospective Study.

INTRODUCTION: Diabetes mellitus (DM) is a complex multisystemic disorder that affects an estimated 21 million Americans. No studies have evaluated the association of DM with the prevalence of each pulpal diagnosis. The objective of this study was to compare the prevalence of each pulp diagnosis including symptomatic irreversible pulpitis (SIP), asymptomatic irreversible pulpitis, reversible pulpitis, normal pulp, and pulp necrosis (PN) in DM patients against a nondiabetic control group. METHODS: A retrospective chart review was approved by Rutgers University Institutional Review Board. The prevalence of the diagnoses SIP, asymptomatic irreversible pulpitis, reversible pulpitis, normal pulp, and PN was calculated from AxiUm (Exan software, Las Vegas, NV) electronic health records at Rutgers School of Dental Medicine. The chi-square test was used to see the relationship between the 2 categoric variables. Second, binary logistic regression analyses were performed for each group. RESULTS: A total of 2979 teeth were diagnosed with a pulp condition between April 2013 and November 2018. The total tooth number of DM patients was 682, whereas the tooth number of nondiabetic patients was 2297. In the subgroup of patients younger than 40 years old, SIP was notably more prevalent in DM patients. In addition, the prevalence of PN in elderly DM patients (60-69 years old) was significantly higher than in the control group. CONCLUSIONS: The prevalence of SIP in DM patients was significantly higher compared with the control group (<40 years old), suggesting the possibility that DM could hypersensitize the subgroup of patients younger than 40 years old to pulpitis pain.

Factors Associated with Incomplete Endodontic Care.

INTRODUCTION: Incomplete endodontic treatment has been associated with detrimental health outcomes. METHODS: This retrospective study reviewed charts of patients receiving endodontic care over a 1-year period at the Postgraduate Endodontic Clinic at Rutgers School of Dental Medicine, Newark, NJ, to assess whether factors such as receipt of palliative endodontic care and demographic factors were associated with completion, or noncompletion, of initial nonsurgical root canal therapy (RCT). RESULTS: A total of 1806 patient charts met the study inclusion criteria. With descriptive statistics and bivariate analysis, the variables of palliative care, Medicaid recipient, age group, and distance from the clinic were significantly associated with RCT completion (P < .05). In the binary logistic regression with all independent variables, palliative care and age group variables were the significant factors (P < .05). Patients who had no palliative care had 8.5 times the odds of completing RCT than patients who had received palliative care. The age group of 18-35 years had 0.59 times the odds of complete RCT than the age group <18 years. CONCLUSIONS: Incomplete nonsurgical endodontic treatment is highly associated with the receipt of prior palliative care. Further research is indicated to investigate additional factors that may influence patient completion of endodontic care and opportunities to improve public health care program design to obtain optimal patient-centered outcomes.

Postendodontic pain: a practical approach to diagnosis and management.

OBJECTIVES: Endodontic treatment is a routine procedure performed by general dental practitioners and endodontists on a daily basis. Fortunately, most patients undergoing endodontic therapy show a favorable outcome with uneventful healing. However, some patients develop pain following endodontic therapy. A majority of these patients develop acute, nociceptive pain ("flare-up") that resolves with appropriate treatment and subsequent healing. The dental profession is very adept at successfully managing the acute pain that occurs early following endodontic treatment. A minority of patients, however, develop ongoing pain following root canal therapy, termed chronic if persisting for 3 months or more. The diagnosis and management of chronic postendodontic pain are often challenging. This article aims to review pain following endodontic therapy, ranging from acute to chronic pain and its management, with specific emphasis on chronic pain, its pathophysiology, clinical features, diagnostic criteria, and management modalities. CONCLUSION: Endodontic treatment rarely leads to chronic neuropathic pain; however, when the nerve injury occurs and results in posttraumatic trigeminal neuropathic pain (PTNP), treatment options are very limited and rarely successful. Therefore, all steps should be taken to avoid nerve injury. Prevention of endodontic treatment related PTNP is crucial and achieved through early recognition, and prompt management.

Chamberless Endodontic Access for Treatment of Calcified Anterior Central Incisors.

INTRODUCTION: Modern techniques for treating maxillary anterior central incisors with calcified canals emphasize maintaining coronal dentin with small crown access. Alternatively, traditional retrograde surgical procedures are focused on creating an apical seal predominately limited to the remaining resected apical one third of the root canal space. A treatment option for calcified anterior teeth, with avoidance of traditional orthograde access, is presented. Chamberless endodontic access (CEA) to the canal is chosen in this case, leveraging a previous surgical treatment and osseous defect to create straight line canal access. METHODS: A tooth presenting with a chronic apical abscess and an apparent previous apical surgery was instrumented and obturated using a CEA avoiding the traditional orthograde approach to the root canal system. Straight line approach was achieved retrograde and canal instrumentation was performed using ultrasonic activated U-files. Canal obturation was accomplished with warm vertical condensation technique followed by placement of an apical retroseal. RESULTS: A successful 52-month outcome demonstrated the viability of CEA facilitating retrograde instrumentation and obturation. CONCLUSIONS: Use of CEA simultaneously protected the clinical crown and provided a successful clinical outcome. A viable option for treatment of an anterior calcified canal and abscess due to dental trauma, CEA mitigates many of the risks associated with the treatment of calcified root anatomy.

Incidence of Middle Mesial Canals Based on Distance between Mesial Canal Orifices in Mandibular Molars: A Clinical and Cone-beam Computed Tomographic Analysis.

INTRODUCTION: This study evaluated the presence of midmesial canals (MMCs) in a random sample of mandibular molars and the relationship of the intracanal distance between mesiobuccal (MB) and mesiolingual (ML) canal orifices. METHODS: Fifty-one extracted mandibular molars were divided into samples of 3 to 4 teeth, mounted in plaster and boxing wax, and immersed in water before cone-beam computed tomographic (CBCT) imaging. Two endodontic residents completed the access openings. The teeth and the CBCT images were interpreted for the presence of MMCs and the mesial intracanal distance. CBCT software measured the distance between the buccal of the MB canal to the lingual of the ML canal at the pulpal floor to determine the average length between the canals. RESULTS: Seven distinct MMCs were seen both clinically (incidence of 13.725%) and on the CBCT images. Twenty-seven teeth (52.94%) had ambiguous broad isthmi between the MB and the ML orifices. MMCs were present at the furcation level but merged with the MB or ML canal toward the apex in 6 of 7 teeth (85.71%). The mean distance between the mesial canals in teeth with MMCs was 3.643 mm, and it was 3.818 mm for teeth without MMCs. According to independent sample t testing, the P value was >.05. CONCLUSIONS: The incidence of MMCs in mandibular molars appears consistent with the literature. However, there does not appear to be a statistically significant difference in the mesial intracanal distance in teeth with and without MMCs. Visualization of MMCs on CBCTs may be subjective. There does not appear to be a correlation between the presence of MMCs and an increased or decreased mesial intracanal distance.