Most dental pain is caused by an organic problem such as dental caries, periodontitis, pulpitis, or trauma. Diagnosis and treatment of these symptoms are relatively straightforward. However, patients often also complain of abnormal dental pain that has a non-dental origin, whose diagnosis is challenging. Such abnormal dental pain can be categorized on the basis of its cause as referred pain, neuromodulatory pain, and neuropathic pain. When it is difficult to diagnose a patient's dental pain, these potential alternate causes should be considered. In this clinical review, we have presented a case of referred pain from the digastric muscle (Patient 1), of pulpectomized (Patient 2), and of pulpectomized pain (Patient 3) to illustrate referred, neuromodulatory, and neuropathic pain, respectively. The Patient 1 was advised muscle stretching and gentle massage of the trigger points, as well as pain relief using a nonsteroidal anti-inflammatory and the tricyclic antidepressant amitriptyline. The pain in Patient 2 was relieved completely by the tricyclic antidepressant amitriptyline. In Patient 3, the pain was controlled using either a continuous drip infusion of adenosine triphosphate or intravenous Mg2+ and lidocaine administered every 2 weeks. In each case of abnormal dental pain, the patient's diagnostic chart was used (Fig.2 and 3). Pain was satisfactorily relieved in all cases.
Adenosine Triphosphate ; Amitriptyline ; Dental Caries ; Diagnosis* ; Humans ; Infusions, Intravenous ; Lidocaine ; Massage ; Neuralgia ; Pain, Referred ; Periodontitis ; Pulpitis ; Trigger Points

BACKGROUND: Endotracheal intubation during anesthesia induction may increase airway resistance (R(aw)) and decrease dynamic lung compliance (Cdyn). We hypothesized that prophylactic treatment with a transdermal β2-agonist tulobuterol patch (TP) would help to reduce the risk of bronchospasm after placement of the endotracheal tube. METHODS: Eighty-two American Society of Anesthesiologists (ASA) category I or II adult patients showing obstructive patterns were divided randomly into a control and a TP group (n = 41 each). The night before surgery, a 2-mg TP was applied to patients in the TP group. Standard monitors were recorded, and target controlled infusion (TCI) with propofol and remifentanil was used for anesthesia induction and maintenance. Simultaneously, end-tidal carbon dioxide, R(aw), and Cdyn were determined at 5, 10, and 15 min intervals after endotracheal intubation. RESULTS: There was no significant difference in demographic data between the two groups. The TP group was associated with a lower R(aw) and a higher Cdyn, as compared to the control group. R(aw) was significantly lower at 10 min (P < 0.05) and 15 min (P < 0.01), and Cdyn was significantly higher at 5 min (P < 0.05) and 15 min (P < 0.01) in the TP group. A trend towards a lower R(aw) was observed showing a statistically significant difference 5 min after endotracheal intubation (P < 0.01) in each group. CONCLUSIONS: Prophylactic treatment with TP showed a bronchodilatory effect through suppressing an increase in R(aw) and a decrease in C(dyn) after anesthesia induction without severe adverse effects.
Adult ; Airway Resistance ; Anesthesia ; Bronchial Spasm ; Carbon Dioxide ; Humans ; Intubation, Intratracheal* ; Lung Compliance ; Propofol ; Respiratory System*

Regardless of whether it is acute or chronic, the assessment of pain should be simple and practical. Since the intensity of pain is thought to be one of the primary factors that determine its effect on a human's overall function and sense, there are many scales to assess pain. The aim of the current article was to review pain intensity scales that are commonly used in dental and oral and maxillofacial surgery (OMFS). Previous studies demonstrated that multidimensional scales, such as the McGill Pain Questionnaire, Short form of the McGill Pain Questionnaire, and Wisconsin Brief Pain Questionnaire were suitable for assessing chronic pain, while unidimensional scales, like the Visual Analogue Scales (VAS), Verbal descriptor scale, Verbal rating scale, Numerical rating Scale, Faces Pain Scale, Wong-Baker Faces Pain Rating Scale (WBS), and Full Cup Test, were used to evaluate acute pain. The WBS is widely used to assess pain in children and elderly because other scales are often difficult to understand, which could consequently lead to an overestimation of the pain intensity. In dental or OMFS research, the use of the VAS is more common because it is more reliable, valid, sensitive, and appropriate. However, some researchers use NRS to evaluate OMFS pain in adults because this scale is easier to use than VAS and yields relatively similar pain scores. This review only assessed pain scales used for post-operative OMFS or dental pain.
Acute Pain ; Adult ; Aged ; Child ; Chronic Pain ; Humans ; Pain Measurement* ; Subject Headings ; Surgery, Oral* ; Toothache ; Weights and Measures ; Wisconsin

Devices that monitor the depth of hypnosis based on the electroencephalogram (EEG) have long been commercialized, and clinicians use these to titrate the dosage of hypnotic agents. However, these have not yet been accepted as standard monitoring devices for anesthesiology. The primary reason is that the use of these monitoring devices does not completely prevent awareness during surgery, and the development of these devices has not taken into account the neurophysiological mechanisms of hypnotic agents, thus making it possible to show different levels of unconsciousness in the same brain status. An alternative is to monitor EEGs that are not signal processed with numerical values presented by these monitoring devices. Several studies have reported that power spectral analysis alone can distinguish the effects of different hypnotic agents on consciousness changes. This paper introduces the basic concept of power spectral analysis and introduces the EEG characteristics of various hypnotic agents that are used in sedation.
Anesthesiology ; Anesthetics* ; Brain ; Consciousness ; Electroencephalography* ; Humans ; Hypnosis ; Hypnotics and Sedatives ; Unconsciousness

In oral and maxillofacial surgery, many complications associated with nasotracheal tube can be caused. In this case, we reported ballooning tube damage of nasotracheal tube during orthognathic double-jaw surgery and replacement of tube through cut down of tube and tube exchange using airway exchange catheter. The patient scheduled for high Le Fort I osteotomy and bilateral sagittal split osteotomy was intubated nasotracheally with nasal endotracheal tube. During maxilla osteotomy, air bubble was detected in the oral blood. In spite of our repeated ballooning, the results were the same so we changed damaged tube using airway exchange catheter aseptically. Tiny and superficial cutting site was detected in the middle of pilot tube. As we know in our case, tiny injury impeded a normal airway management and prevention is important.
Airway Management ; Catheters ; Humans ; Intubation ; Maxilla ; Orthognathic Surgery ; Osteotomy ; Surgery, Oral

One complication related to local anesthesia in the dental clinic is a broken needle. Although rare, a broken needle may be difficult to retrieve. Dental radiographs and 3D CT have been used in the past to confirm the location of a broken needle. We present the case of a broken needle, which was successfully removed using a careful, microscopic approach.
Anesthesia, Local ; Dental Clinics ; Needles*

Although inferior alveolar nerve block is one of the most common procedures performed at dental clinics, complications or adverse effects can still occur. On rare occasions, ocular disturbances, such as diplopia, blurred vision, amaurosis, mydriasis, abnormal pupillary light reflex, retrobulbar pain, miosis, and enophthalmos, have also been reported after maxillary and mandibular anesthesia. Generally, these symptoms are temporary but they can be rather distressing to both patients and dental practitioners. Herein, we describe a case of diplopia caused by routine inferior alveolar nerve anesthesia, its related physiology, and management.
Anesthesia ; Blindness ; Dental Clinics ; Diplopia* ; Enophthalmos ; Humans ; Mandibular Nerve* ; Miosis ; Mydriasis ; Physiology* ; Reflex

BACKGROUND: Many people experience varying levels of discomfort when confronted with the prospect of dental treatment. Dental treatment can be a traumatic experience, especially for children and adolescents with dental anxiety. In this age group, dental fear causes a significant problem in dental management and has been related to severe dental caries and dental pain. The Dental Fear Survey ( DFS ) is the most widely used measure of dental fear. This study was undertaken to develop the Korean version of the DFS ( K-DFS ) and test its reliability and validity. METHODS: The K-DFS, which uses projective techniques to measure children's and adolescents' dental fear, was developed. The DFS was translated into Korean and participants were selected via convenience sampling. Reliability and validity were tested using data from a sample of 813 middle school students in Gyeonggi Province, selected from the Self questionnaire survey. The K-DFS was administered twice to 102 adolescents aged 12-15 years. RESULTS: The K-DFS had high internal consistency reliability (99.1%) but low test-retest reliability. CONCLUSIONS: The results indicate that the Korean versions of the DFS have good internal consistency reliabilities and test-retest validities. However, we need to further examine the test-retest reliability of the K-DFS and replicate the current study in different samples covering various age groups.
Adolescent ; Anxiety ; Child ; Dental Anxiety* ; Dental Caries ; Gyeonggi-do ; Humans ; Projective Techniques ; Reproducibility of Results*

BACKGROUND: To prepare for possible emergency situations during dental treatment, it is helpful to know how often and what kinds of emergencies may arise. This study set out to evaluate the incidences, causes, treatments, and outcomes of emergency situations in the outpatient clinic of a dental teaching hospital in Korea. METHODS: We retrospectively reviewed the records of patients who had experienced an emergency situation and emergency response team activated in a selected outpatient clinic between November 2004 and November 2013. Specific information about the emergency cases was collected, including the patient characteristics and the frequency, types, treatments, and outcomes of the emergency situations. RESULTS: We identified 35 instances of emergency situations in 2,890,424 patients (incidence = 0.012 per 10,000 outpatients). The number of cases was as follows: 10 (28.6%) in the Department of Periodontics, 10 (28.6%) in the Department of Oral and Maxillofacial Surgery, 6 (17.1%) in the Department of Oral and Maxillofacial Radiology, 4 (11.4%) in the Department of Prosthodontics, 2 (5.7%) in the Department of Conservative Dentistry, 2 (5.7%) in the Department of Pediatric Dentistry, and 1 (2.9%) in the Department of Orthodontics. Three (8.6%) of the emergency situations arose before treatment, 22 (62.9%) during treatment, 7 (20.0%) after treatment, and 2 (5.7%) in a patient's guardian. CONCLUSIONS: In accordance with the growing elderly population and more aggressive dental procedures, the number of emergency situations may increase in the future. We recommend that clinicians keep in mind airway management and the active control of emergency situations.
Aged ; Airway Management ; Ambulatory Care Facilities* ; Dentistry ; Emergencies* ; Emergency Medical Services ; Hospital Rapid Response Team ; Hospitals, Teaching* ; Humans ; Incidence ; Korea* ; Orthodontics ; Outpatients* ; Pediatric Dentistry ; Periodontics ; Prevalence ; Prosthodontics ; Retrospective Studies* ; Surgery, Oral

BACKGROUND: There have been few studies on the effect of an elevated concentration of lidocaine hydrochloride in the surgical removal of an impacted lower third molar. This study aimed to examine the efficacy of 4% lidocaine along with 1:100,000 epinephrine compared to 2% lidocaine along with 1:100,000 epinephrine as inferior alveolar nerve block for the removal of an impacted lower third molar. METHODS: This single-blind study involved 31 healthy patients (mean age: 23 y; range: 19-33 y) with symmetrically impacted lower third molars as observed on panoramic radiographs. Volunteers required 2 surgical interventions by the same surgeon with a 3-week washout period. The volunteers were assigned either 4% lidocaine with 1:100,000 epinephrine or 2% lidocaine with 1:100,000 epinephrine as local anesthetic during each operation. RESULTS: We recorded the time of administration, need for additional anesthetic administration, total volume of anesthetic used. We found that the patient's preference for either of the 2 types of local anesthetic were significantly different (P < 0.05). However, the extent of pulpal anesthesia, surgical duration, and duration of soft tissue anesthesia were not significantly different. CONCLUSIONS: Our study suggested that inferior alveolar nerve block using 4% lidocaine HCl with 1:100,000 epinephrine as a local anesthetic was clinically more effective than that using 2% lidocaine HCl with 1:100,000 epinephrine; the surgical duration was not affected, and no clinically adverse effects were encountered.
Anesthesia ; Epinephrine ; Humans ; Lidocaine* ; Mandibular Nerve ; Molar, Third* ; Single-Blind Method ; Volunteers