Humans ; Pulpitis ; diagnosis

OBJECTIVES: Assessment of dental pain severity is very challenging in dentistry. Previous studies have suggested that elevated salivary alpha amylase may contribute to increased physical stresses. There is a close association between salivary alpha amylase and plasma norepinephrine under stressful physical conditions. The aim of this study was to evaluate the relationship between pain severity and salivary alpha amylase levels in patients with symptomatic irreversible pulpitis. MATERIALS AND METHODS: Thirty-six patients (20 females and 16 males) with severe tooth pain due to symptomatic irreversible pulpitis were selected. The visual analogue scale (VAS) score was used to assess the pain severity in each patient. Unstimulated whole saliva was collected, and the level of alpha amylase activity was assessed by the spectrophotometric method. Statistical analysis was performed using SPSS 13. RESULTS: The level of alpha amylase was significantly increased in the saliva in association with pain severity assessed by VAS. The salivary alpha amylase was also elevated with increased age and in males. CONCLUSIONS: There was a significant correlation between the VAS pain scale and salivary alpha amylase level, which indicates this biomarker may be a good index for the objective assessment of pain intensity.
alpha-Amylases ; Dentistry ; Female ; Humans ; Norepinephrine ; Plasma ; Pulpitis ; Saliva ; Tooth

This study was performed to prepare the quantitative method of judging the sensitive prognosis of chronic apical periodontitis as early as possible. The subjects were 25 cases with periapical radiolucencies of which were treated with endodontic treatment. Serial radiographs were taken by standardized method longitudinally. The density slice function of digital radiographic system were employed for quantitative and longitudinal assessment of the radiolucent area and the condensing osteitis simultaneously. Obtained results were as follows: 1. The amount of bone repair after endodontic treatment could be detected quantitatively by the density slice function of digital radiographic system. 2. Within the 6-week period after root canal filling, the prognosis could be evaluated by assessment both radiolucent area and condensing osteitis on digital radiographic system. 3. The pattern of bone repair showed peripheral type in most cases from the 6th week after root canal filling. 4. In longitudinal change, bone repair showed two patterns; the succeeding reduction of radiolucent area showing the increase of condensing osteitis in size till 6th week and following by static state or reduction tendency and the reduction following the initial increase of both areas. 5. Cases with pulpitis by trauma showed initial increase of condensing osteitis at 2nd week, marked reduction of radiolucent area and condensing osteitis at 6th week, and approximately normal bone state at 8th week after root canal filling.
Dental Pulp Cavity ; Osteitis ; Periapical Periodontitis ; Prognosis ; Pulpitis ; Radiography*

Pain and pain control are important to the dental profession because the general perception of the public is that dental treatment and pain go hand in hand. Successful dental treatment requires that the source of pain be detected. If the origin of pain is not found, inappropriate dental care and, ultimately, extraction may result. Pain experienced before, during, or after endodontic therapy is a serious concern to both patients and endodontists, and the variability of discomfort presents a challenge in terms of diagnostic methods, endodontic therapy, and endodontic knowledge. This review will help clinicians understand the basic neurophysiology of pulpal pain and other painful conditions of the dental pulp that are not well understood.
Dental Care ; Dental Pulp ; Hand ; Humans ; Inflammation ; Neurophysiology ; Pulpitis

OBJECTIVEThis study aims to investigate the positioning accuracy of acute pulpitis pain and its possible factors.

METHODSThe clinical symptoms and physical signs of 3 432 cases of acute pulpitis were recorded and analyzed by using questionnaire forms, which included age, gender, tooth position, infection origin, pain history, time of acute attack, duration and nature of pain, pain frequency, referred pain areas, percussion examination, temperature pulp test, pulp bleeding, and positioning accuracy. Univariate analysis and multivariate stepwise regression analysis were used for data processing.

RESULTSPain location was accurately identified by 39.1% of the patients with acute pulpitis. Referred pain could reduce the positioning accuracy of pain (P < 0.05), whereas infection originating from the periodontium could raise it (P < 0.05). Other factors might not be directly related to positioning accuracy (P > 0.05).

CONCLUSIONSome cases of acute pulpitis pain can be located accurately. Referred pain and periodontium infection origin are related to the positioning accuracy of acute pulpitis pain. The exact cause of this correlation needs further study.

In recent years, great progress has been made in research on the treatment of pulpitis, mainly due to the rapid development of basic and clinical researches in this field, and some achievement from basic research has been applied in clinical practice. Advances in the diagnostic methods for pulpitis can help the clinicians to recognize the true state of pulpitis more accurately and to adopt the corresponding treatment methods including indirect/direct pulp capping, pulpotomy, pulp regeneration and root canal therapy. The new theory of pulpitis diagnosis and the studies on immune defense, repair function of dental pulp and new pulp capping materials have significantly improved the success rate of vital pulp therapy. For diffuse coronary pulpitis or radicular pulpitis, which is difficult to achieve vital pulp therapy successfully, methods of pulp revascularization, cell homing and pulp stem cells-mediated pulp regeneration can also be used as treatment options in addition to root canal therapy. The present article focuses on the research progress on pulpitis treatments and related clinical transformation practices, in order to provide reference on vital pulp therapy and pulp regeneration for clinicians.
Dental Pulp ; Dental Pulp Capping ; Humans ; Pulpitis/therapy* ; Pulpotomy ; Regeneration

The objective of this review was to investigate the efficacy of dental local anesthetics, as it is well known among clinicians that local anesthesia may be challenging in some circumstances. Therefore, the focus of this review was on the efficacy of the products used in dental local anesthesia. In a Pubmed database literature search conducted, a total of 8646 articles were found to be related to dental local anesthetics. After having applied the inclusion criteria (human research, performed in the last 10 years, written in English language, and focus on dental local anesthetics) and having assessed the quality of the papers, 30 were deemed eligible for inclusion in this review. The conclusion of this review is that none of the dental local anesthetic amides provide 100% anesthesia. The problem appears to be more pronounced when mandibular teeth are attempted to be anaesthetized and especially if there is irreversible pulpitis involved. The authors conclude that this finding suggest exploration of more efficient techniques to administer dental local anesthesia, especially in the mandible, to establish a 100% efficacy, is needed.
Amides ; Anesthesia ; Anesthesia, Local ; Anesthetics, Local ; Mandible ; Pulpitis ; Tooth

Root canal anatomy is complex, and the recognition of anatomic variations could be a challenge for clinicians. This case report describes the importance of cone beam computed tomographyic (CBCT) imaging during endodontic treatment. A 23 year old woman was referred by her general dental practitioner with the chief complaint of spontaneous pain in her right posterior maxilla. From the clinical and radiographic findings, a diagnosis of symptomatic irreversible pulpitis was made and endodontic treatment was suggested to the patient. The patient underwent CBCT examination, and CBCT scan slices revealed seven canals: three mesiobuccal (MB1, MB2, and MB3), two distobuccal (DB1 and DB2), and two palatal (P1 and P2). Canals were successfully treated with reciprocating files and filled using single-cone filling technique. Precise knowledge of root canal morphology and its variation is important during root canal treatment. CBCT examination is an excellent tool for identifying and managing these complex root canal systems.
Cone-Beam Computed Tomography* ; Dental Pulp Cavity* ; Diagnosis ; Female ; Humans ; Maxilla ; Molar* ; Pulpitis

It is often presumed that apical periodontitis follows total pulp necrosis, and consequently root canal treatment is commonly performed. Periapical lesion development is usually caused by bacteria and its byproduct which irritate pulp, develop pulpitis, and result in necrosis through an irreversible process. Afterwards, apical periodontitis occurs. This phenomenon is observed as an apical radiolucency in radiographic view. However, this unusual case presents a spontaneous healing of periapical lesion, which has developed without pulp necrosis in a vital tooth, through conservative treatment.
Bacteria ; Dental Pulp Cavity ; Dental Pulp Necrosis ; Necrosis ; Neurogenic Inflammation ; Periapical Periodontitis ; Pulpitis ; Tooth

The purpose of this study was to assess the incidence of flare-ups among patients who received endodontic treatment and to examine the correlation with pre-operative and operative variables. Analysis was in two aspects (a) overall incidence of flare-ups as expressed by a percentage of all patients visits and (b) percentage of flare-ups that occurred as related to various factors such as patient demographics, diagnosis, and treatment procedures. 1. From the 840 teeth which were examined in this study, the total number of flare-ups was 13. 2. As to gender of patients, there was no significant difference in flare-ups. 3. As to tooth groups, there was no significant difference in flare-ups. 4. In the teeth with pre-operative symptom, there was a statistically significant higher incidence of flare-ups than the teeth without it. 5. In the teeth with apical periodontitis, there was a statistically significant higher incidence of flare-ups. 6. As to pulp and periapical status, non-vital teeth had a higher incidence as compared with vital teeth, irreversible pulpitis. 7. Multi-visit treatment resulted in the higher incidence of flare-ups than one visit treatment. 8. Re-treatment procedures had a statistically significant higher incidence of flare-ups than root canal treatment. In this study, overall percentages of flare-ups was 1.55%. It showed a statistically significant higher incidence related to pre-operative symptom, apical periodontitis, and re-treatment. There was no significant difference in flare-ups related to gender, tooth groups, and fistula.
Demography ; Dental Pulp Cavity ; Diagnosis ; Fistula ; Humans ; Incidence* ; Periapical Periodontitis ; Pulpitis ; Tooth