Changes in Functional Connectivity of Specific Cerebral Regions in Patients with Toothache: A Resting-State Functional Magnetic Resonance Imaging Study.

OBJECTIVE: In order to further study the changes of cerebral functional connectivity in patients with toothache (TA), this study used the resting-state functional magnetic resonance imaging (rs-fMRI) technique and degree centrality (DC) analysis method. METHODS: Eighteen TA patients (8 males, 10 females) and 18 healthy individuals of similar age, sex, and educational levels were recruited as healthy controls (HCs) to take part in the study, and all underwent rs-fMRI examination. And DC technology was used to compare the state of their cerebral spontaneous functional activity. In order to compare the average DC values of the TA group and HC group, we used independent two-sample t-test and receiver operating characteristic (ROC) curve to compare the difference of DC values between the two groups, so as to distinguish the accuracy of TA diagnosis. Finally, we also carry out Pearson's linear regression analysis. RESULTS: The TA group showed higher DC values in the right lingual gyrus (RLG), right precentral gyrus, and left middle temporal gyrus (LMTG) than HCs. Moreover, ROC curve analysis indicated that the area under the curve (AUC) of each cerebral region studied had high accuracy. In addition, linear analysis indicated that the DC values of the RLG were positively correlated with the Hospital Anxiety and Depression Scale (HADS) (r = 0.844, p < 0.001), and the DC values of the LMTG were positively correlated with the visual analogue scale (VAS) (r = 0.723, p < 0.001). CONCLUSION: TA generates abnormal changes in the intrinsic activity patterns of pain-related and vision-related areas of the cerebral cortex, which will be beneficial to reveal the underlying neuropathic mechanisms.

Computed tomography window blending in maxillofacial imaging.

PURPOSE: The purpose of this study was to demonstrate the ability of a custom window blending algorithm to depict multicompartmental disease processes of the maxillofacial region in a single image, using routine computed tomography (CT) DICOM data. METHODS: Five cases were selected from case files demonstrating trauma, infection, and malignancy of the maxillofacial region on routine CT examinations. Images were processed with a modified Relative Attenuation-Dependent Image Overlay (RADIO) window-blending algorithm in Adobe Photoshop controlled by ExtendScript. RESULTS: The modified RADIO algorithm was able to demonstrate pertinent multicompartmental imaging findings in each of the examinations, allowing simultaneous visualization of clinically relevant bone and soft tissue findings in a single image, without needing to change window and level settings. CONCLUSION: A custom window blending algorithm can demonstrate a range of multicompartmental pathology in the maxillofacial region in a single image.

A 2-year retrospective study of pediatric dental emergency visits at a hospital emergency center in Taiwan.

BACKGROUND: There is a paucity of information regarding pediatric dental emergencies in Taiwan. This study investigates the prevalence and characteristics of the pediatric dental emergency services provided at a medical center. METHODS: This study included a retrospective chart review of patients under 18 years of age with dental complaints who visited the Emergency Department (ED) of Linkou Medical Center of Chang Gung Memorial Hospital from January 2012 to December 2013. Information regarding age, gender, time/day/month of presentation, diagnosis, treatment, and follow-up was collected and analyzed. Statistical analysis included descriptive statistics and Pearson's Chi-square test with the significance level set as p < 0.05. RESULTS: This study revealed that dental emergencies in the medical center ED were predominantly related to orodental trauma (47.1%) and pulpal pain (29.9%). Most patients were male (p < 0.001) and <5 years of age (p < 0.001). The most frequent orodental trauma was luxation, both in primary and permanent dentition. The major management for dental emergencies was prescribing medication for pulp-related problems and orodental trauma. The follow-up rate of orodental trauma was the highest (p < 0.001). CONCLUSIONS: For children, trauma and toothache constituted the most common reasons for dental emergency visits at a hospital emergency center in Taiwan. While dental emergencies are sometimes unforeseeable or unavoidable, developing community awareness about proper at-home care as well as regular dental preventive measures can potentially reduce the number of emergency visits.

A comparative analysis of magnetic resonance imaging and radiographic examinations of patients with atypical odontalgia.

AIMS: To examine (1) the occurrence of magnetic resonance imaging (MRI) signal changes in the painful regions of patients with atypical odontalgia (AO) and (2) the correlation of such findings to periapical bone defects detected with a comprehensive radiographic examination including cone beam computed tomography (CBCT). METHODS: A total of 20 patients (mean age 52 years, range 34 to 65) diagnosed with AO participated. Mean pain intensity (± standard deviation) was 5.6 ± 1.8 on a 0-10 numerical rating scale, and mean pain duration was 4.3 ± 5.2 years. The inclusion criterion was chronic pain (> 6 months) located in a region with no clear pathologic cause identified clinically or in periapical radiographs. In addition to a clinical examination and a self-report questionnaire, the assessments included radiographic examinations (panoramic, periapical, and CBCT images), and an MRI examination. Changes in MRI signal in the painful region were recorded. Spearman's rank correlation between radiographic and MRI findings was calculated. RESULTS: Eight of the patients (40%) had MRI signal changes in the pain region. The correlation to radiographic periapical radiolucencies was 0.526 (P = .003). Of the eight teeth displaying changes in MRI signal, six showed periapical radiolucency in the radiographs. CONCLUSION: MRI examination revealed no changes in the painful region in a majority of patients with AO, suggesting that inflammation was not present. MRI findings were significantly correlated to radiographic findings.

Role of ultrasonography in differentiating facial swellings of odontogenic origin.

INTRODUCTION: Differentiating an acute, odontogenic facial swelling clinically as cellulitis or an abscess has not been thoroughly investigated in endodontics. It has been suggested in the medical and dental literature that the use of ultrasound may aid in differentiating cellulitis from an abscess. Therefore, if ultrasound were more accurate than a blind incision for drainage procedure in locating purulence, perhaps the outcome of the incision for drainage procedure would be beneficial in the resolution of odontogenic infections. The purpose of this prospective study was to compare clinical examination plus ultrasonography versus clinical examination alone in differentiating cellulitis from abscesses in patients with facial swelling of odontogenic origin. METHODS: Eighty-two emergency patients participated in this study. Each patient was examined and diagnosed by clinical examination and clinical examination plus ultrasonography. An incision for drainage procedure was performed, and a definitive diagnosis was recorded as cellulitis (no purulence) or an abscess (presence of purulence). RESULTS: With the incision for drainage procedure, cellulitis occurred 37% of the time and abscesses 63%. With clinical examination alone, a correct diagnosis was made 68% of the time. With clinical examination plus ultrasonography, a correct diagnosis was made 70% of the time. There was no statistically significant difference between the 2 examination methods. CONCLUSIONS: The addition of ultrasonography to a clinical examination did not significantly increase the number of correct diagnoses.

Maxillary premolar with 4 separate canals.

INTRODUCTION: Recognition of anatomic variations is a challenge for clinicians regardless of which tooth is treated. Maxillary premolars usually have 2 root canals, but the presence of 3 distinct root canals has been reported in 1%-6% of cases. METHODS AND RESULTS: This report describes the case of a maxillary right second premolar with 4 separate canals: 1 mesial, 1 palatal, and 2 distal canals. This was confirmed by using cone-beam computed tomography and was successfully treated with rotary files and obturated by using a warm vertical compaction technique. CONCLUSIONS: The clinical significance of the present case is that this is the first report of 3 roots and 4 separate canals in a maxillary premolar. Precise knowledge of root canal morphology and its variation is also underlined. Cone-beam computed tomography examination and the operating microscope are excellent tools for identifying and managing these complex root canal systems.

A rare root canal configuration of bilateral maxillary first molar with 7 root canals diagnosed using cone-beam computed tomographic scanning: a case report.

INTRODUCTION: The complexity of the root canal system of maxillary molars presents a constant challenge in the diagnosis and treatment of these teeth. This case report describes the importance of a surgical operating microscope and cone-beam computed tomographic (CBCT) imaging. METHODS: Root canal treatment of a left maxillary first molar with 3 roots and 7 canals was successfully performed. Seven canals were identified with the help of a surgical operating microscope and CBCT imaging. CBCT images also confirmed the 3 roots and 7 canals in the right maxillary first molar. RESULTS: CBCT images confirmed a type IV canal pattern in the distal and palatal root, whereas the mesial root had a type VIII canal pattern. CONCLUSIONS: The use of a surgical operating microscope and CBCT imaging helps the clinician to diagnose unusual anatomy of a tooth and facilitate successful endodontic treatment.

'Intranasal toothache': case report.

OBJECTIVE: This paper describes a patient with recurrent unilateral nasal discomfort and pain due to an intranasal tooth. A short overview of the literature is provided in relation to the aetiology, symptomatology, diagnosis and treatment of intranasal teeth. CASE REPORT: A 26-year-old man was referred with a history of recurrent left-sided nasal obstruction, facial pain and discomfort, and chronic purulent rhinorrhoea. Computed tomography revealed a nasal tooth, which was likely to have been the cause of these symptoms. After transnasal surgical extraction under endoscopic guidance, the patient was relieved of his complaints (at the one-year follow up). CONCLUSION: An ectopic tooth in the nasal cavity is a rare phenomenon, and in most cases the cause of an intranasal tooth remains unclear. The treatment of an intranasal tooth entails surgical extraction even though such teeth may remain asymptomatic; several cases have illustrated the potential significant morbidity associated with their occurrence.

Dor pós operatória em dentes com infecções após única ou múltiplas sessões - revisão sistemática / Postoperative pain in infected teeth after single - versus multiple-visit endodontic treatment - a systematic review

Objetivo: Verificar a presença de dor pós-operatória em dentes com infecções que receberam a terapia endodôntica em sessão única (após obturação) e múltiplas sessões (após uso de medicação intracanal), através de revisão sistemática. Método: Realizou-se pesquisa em fonte de catalogação bibliográfica identificada eletronicamente por MEDLINE, entre 1966 a 20 de fevereiro de 2011. Como estratégia de busca foram utilizados os termos com a expressão "and": single visit root canal treatment, single visit root canal therapy, multiple visit root canal treatment, multiple visit root canal therapy, single visit root canal treatment postoperative pain, single visit root canal therapy postoperative pain, multiple visit root canal treatment postoperative pain, multiple visit root canal therapy postoperative pain, Calcium Hydroxide intracanal medicament, Calcium Hydroxide intracanal medicament postoperavite pain. Resultados: Foram encontrados 278 artigos. Para seleção, critérios de inclusão foram estabelecidos em duas etapas, na primeira 15 trabalhos foram selecionados. Na segunda, como critério de inclusão, trabalhos que continham a avaliação da dor em polpas vivas e necrosadas e que não avaliaram a dor, somente após a obturação em sessão única, e após a medicação intracanal, em sessões múltiplas foram descartados. Do total encontrado, 2 artigos atenderam aos critérios de inclusão. Conclusões: Baseado na análise dos trabalhos selecionados a partir dos critérios de inclusão deste estudo, dentes que receberam a medicação intracanal, a qual foi o hidróxido de cálcio, apresentaram menor intensidade de dor pós operatória, tratamentos de dentes sintomáticos (dor prévia) revelaram os maiores índices de desconforto pós-operatório independente de sessão única ou múltipla.

Objective: To verify the presence of postoperative pain in teeth with infections who received endodontic therapy in one session (after filling) and multiple sessions (after intracanal medication), through a systematic review. Methods: A research was conducted in the MEDLINE full-text electronic database between 1966 and February 20, 2011. The following key words were used with the expression "and" to narrow the search: single visit root canal treatment, single visit root canal therapy, multiple visit root canal treatment, multiple visit root canal therapy, single visit root canal treatment postoperative pain, single visit root canal therapy postoperative pain, multiple visit root canal treatment postoperative pain, multiple visit root canal therapy postoperative pain, Calcium Hydroxide intracanal medicament, Calcium Hydroxide intracanal medicament postoperative pain. Results: The search retrieved 278 articles, of which 28 were literature reviews, 15 case reports, 16 meta-analyses and systematic reviews. Among the other studies, 33 were in vitro, 10 were in animals, 6 were retrospective and 5 were in primary teeth. Regarding the number of sessions, 47 articles were found, including 12 on intracanal medication, 14 on systemic medication and 6 flare-ups. Papers without an abstract were 36 and 50 were classified as other (rehabilitation, fractures, incomplete apex formation, etc.). Out of the total of papers retrieved, only two met the inclusion criteria. Conclusions: Teeth that received calcium hydroxide intracanal medication showed lower intensity of postoperative pain, treatment of symptomatic teeth (previous pain) showed the highest rates of postoperative discomfort regardless if treated in single or multiple sessions.

Detection of vertical root fractures by using cone-beam computed tomography: a clinical study.

INTRODUCTION: Vertical root fractures of teeth (VRFs) often pose a diagnostic dilemma because of the difficulty in detection of these in intraoral radiographs except in certain cases with very distinct clinical findings. This often leads to unwarranted extraction of the tooth. Cone-beam computed tomography (CBCT) produces three-dimensional images and allows precise visualization and evaluation of VRFs or cracks in extracted teeth, as reported previously. This clinical pilot study was designed to determine the diagnostic accuracy of noninvasive CBCT for detection of suspected VRFs in endodontically treated teeth by using exploratory surgery to confirm the presence or absence of a fracture. METHODS: Thirty-two teeth in 29 patients with clinical signs and symptoms suggestive of VRF were included in the study after informed consent was obtained. They underwent a limited area CBCT evaluation. All CBCT studies were blinded, and 2 board-certified oral and maxillofacial radiologists assessed the presence or absence of VRF through sequential evaluation of the three-dimensional volume. Subjects underwent surgical exploration as part of treatment, which helped establish the presence or absence of VRF. RESULTS: Pearson correlation coefficient by using surgical finding to confirm presence/absence of fracture was 0.602, positive predictive value was 91%, and negative predictive value was 67%. The sensitivity was 88%, and specificity was 75%. CONCLUSIONS: This study revealed the superior diagnostic accuracy of CBCT for detection of VRF.

Diagnostic yield of conventional radiographic and cone-beam computed tomographic images in patients with atypical odontalgia.

AIM: To investigate whether the additional diagnostic yield of a cone-beam computed tomography (CBCT) examination over conventional radiographs in patients primarily suspected of having atypical odontalgia (AO) improves differentiation between AO and symptomatic apical periodontitis (SAP) in patients with severe chronic intraoral pain. METHODOLOGY: In this clinical study, 25 patients (mean age 54 ± 11 years, range 34-72) participated; 20 were diagnosed with AO and 5 with SAP. All patients were recruited from the clinics of the Faculty of Odontology, Malmö University. AO inclusion criteria were chronic pain (>6 months) in a region where a tooth had been endodontically or surgically treated, with no pathological cause detectable in clinical or radiologic examinations. SAP inclusion criteria were recurrent pain from a tooth diagnosed with apical periodontitis in clinical and radiographic examinations. Assessments comprised a self-report questionnaire on pain characteristics, a comprehensive clinical examination and a radiographic examination including panoramic and intraoral radiographs and CBCT images. The main outcome measure was periapical bone destruction. RESULTS: Sixty per cent of patients with AO had no periapical bone destructions detectable with any radiographic method. Overall, CBCT rendered 17% more periapical bone destructions than conventional radiography. Average pain intensity in patients with AO was 5.6 (± 1.8) on a 0-10 numerical rating scale, and average pain duration was 4.3 (± 5.2) years. CONCLUSION: Cone-beam computed tomography improves identification of patients without periapical bone destruction, which may facilitate differentiation between AO and SAP.

Submasseteric abscess: a rare head and neck abscess.

The objective of the article is to highlight and make people aware of a rare abscess which is often missed or misdiagnosed. As only a few cases have been reported, the authors feel that reporting such a case would help in proper management of the disease. We are presenting a 6.5-year-old male child with 3 weeks history of right facial swelling in the parotid region, with low-grade fever and trismus. Submasseteric abscess is a rare abscess which is often misdiagnosed as a parotid abscess or parotitis. Only a few cases have been reported. The cause is mostly dental in origin. Intravenous antibiotics often fail to alleviate the symptoms as this is a closed space and needs prompt drainage. Therefore, awareness of this complication of dental infections is vital for proper diagnosis and timely management.

Foreign body in a deciduous incisor: a radiological revelation.

A 6-year-old boy was brought to the dental department with a history of toothache in the anterior maxillary region. Intraoral examination revealed caries in the deciduous upper central and lateral incisor teeth. Radiological evaluation revealed the silhouette of a metallic paper clip in the pulp chamber of the deciduous right maxillary central incisor. The tooth was extracted as the permanent incisor was erupting below. Children often avoid informing their parents regarding such incidents due to fear of punishment.

MRI features of mandibular osteomyelitis: practical criteria based on an association with conventional radiography features and clinical classification.

OBJECTIVES: The aims of this study were (1) to assess the diagnostic power of magnetic resonance imaging (MRI) for mandibular osteomyelitis through comparison with conventional techniques and (2) to establish practical MRI diagnostic criteria in relation to treatment and clinical outcome. STUDY DESIGN: In 55 subjects, clinically suspected as mandibular osteomyelitis, signal intensities (SI) were evaluated on T1-weighted/short T1 inversion recovery (STIR) images. RESULTS: Forty-seven subjects were definitively diagnosed as having osteomyelitis by pathology studies or clinical course. For the acute or subacute stage, positively associated appearances were low SI on T1-weighted image and extensive high or focal high SI on the STIR image. For chronic stage, appearances of low SI on both T1-weighted and STIR images should be added to those for the acute or subacute stage. These findings support the at-present accepted imaging diagnostic criteria based on bony changes for detection of osteomyelitis. CONCLUSION: This study confirms that T1-weighted/STIR images are useful for the detection of mandibular osteomyelitis.

Endodontic management of a mandibular second premolar with four roots and four root canals with the aid of spiral computed tomography: a case report.

Aberrations in the root canal anatomy are a commonly occurring phenomenon. A thorough knowledge of the basic root canal anatomy and its variations is necessary for successful completion of the endodontic treatment. Mandibular second premolars usually have a single root and a single root canal. The incidence of three separate roots itself in this tooth is quite rare, and the presence of four separate roots and four distinct root canals has never been reported in literature so far. The use of spiral computed tomography scan in this rare case greatly contributed towards making a confirmatory diagnosis and successful nonsurgical endodontic management thereafter.

Atypical odontalgia: a case report.

Diagnosis and treatment of orofacial pain is not uncommon; however, reaching a definitive diagnosis in these cases can be a complex challenge. Dentists are most likely to face this situation, because persistent and chronic pain is more common in the head and neck region than in any other part of the body. However, the complexities and diagnostic challenges mean that misdiagnosing neuropathic pain is common. This article presents a case of atypical odontalgia and illustrates the complexities involved when diagnosing the condition.