Postoperative pain commonly follows dental procedures, and appropriate analgesic selection plays a critical role in its management. This systematic review evaluated the efficacy and safety of tenoxicam compared with other pharmacological agents for postoperative dental pain control. Indexed databases, including PubMed, EMBASE, Ovid, Scopus, Web of Science, and the Cochrane Library, were searched through August 2025. Risk of bias was assessed using the Cochrane Risk of Bias tool for interventions. Nine randomized controlled trials met the inclusion criteria and covered a range of dental procedures, including third molar extraction, endodontic treatment, orthodontic adjustment, and implant surgery. Comparators included placebo, ibuprofen, diclofenac, flurbiprofen, meloxicam, methylprednisolone, and rofecoxib. Pain outcomes were measured primarily with the Visual Analogue Scale at multiple postoperative time points. Across studies, tenoxicam showed analgesic efficacy that was generally superior or comparable to other agents, with several trials reporting statistically significant reductions in pain scores at both early and later postoperative intervals. Most studies had low overall risk of bias, although some raised concerns related to allocation concealment and outcome reporting. Tenoxicam appears to be an effective and well-tolerated option for postoperative dental pain management. Study heterogeneity and domain-level bias concerns indicate a need for additional high-quality trials to confirm these findings and support routine clinical use.

Background: Dental pain is the most common chief complaint in oral healthcare and involves multiple disease types. An accurate diagnosis is crucial for treatment decisions. Large language models (LLMs) have great potential for medical diagnosis; however, their accuracy in dental pain diagnosis has not been systematically evaluated.The objectives of this study were to evaluate the diagnostic accuracy of four advanced LLMs for dental pain and analyze the key factors affecting diagnostic performance. Methods: A comparative study was conducted using 320 dental pain cases from authoritative sources covering eight disease categories. Four state-of-the-art LLMs were evaluated: DeepSeek-R1, ChatGPT-4o, Claude-3.5 Sonnet, and Gemini Pro 2.0. A blinded evaluation was performed by senior experts. The primary outcome was overall diagnostic accuracy, and the secondary outcomes included performance across disease types, complexity levels, and confidence levels. Results: DeepSeek-R1 achieved the highest diagnostic accuracy (83.8%), followed by ChatGPT-4o (82.8%), with no significant differences. Pulpal disease had the highest accuracy (88.1%), whereas neurological pain had the lowest (59.4%). The case complexity significantly affects the accuracy. The AI models demonstrated significant time advantages, representing a 94.2% faster diagnostic speed than human experts. Conclusion Latest-generation LLMs, particularly DeepSeek-R1 and ChatGPT-4o, achieved diagnostic levels approaching those of specialist physicians while providing substantial time efficiency gains. These findings support the application of AI in oral medicine by using confidence-based stratified implementation strategies.

Background: Inferior alveolar nerve block (IANB) is the standard anesthetic approach for mandibular first molars;however, it has well-documented limitations, including variable success rates, delayed onset, higher anesthetic dose requirements, and potential complications. The TuttleNumbNow (TNN) anesthesia protocol introduces intraosseous (IO) injections as the primary anesthetic modality, followed by infiltration and IANB as a last resort. This approach seeks to provide rapid site-specific anesthesia at reduced pharmacological doses. This study evaluated the clinical efficacy of the TNN protocol for mandibular first molar procedures in a private practice setting. Methods: This retrospective observational study reviewed patient records from Tuttle Family Dental (Orem, Utah, USA) between January and December 2023. Eligible cases included patients undergoing composite restorations, crown preparations, or crown seating on the mandibular first molars, where anesthesia was administered according to the TNN protocol. Data were extracted from Eaglesoft electronic dental records and categorized as follows:no anesthetic, single-agent TNN (articaine 4% with epinephrine 1:100,000 or mepivacaine 3% without epinephrine), dual-agent TNN, or conversion to IANB. Descriptive statistics summarized the anesthetic regimens, and Fisher’s exact test assessed the association between procedure type and IANB conversion. Results: In total, 184 cases (74 composites, 57 crown preparations, and 53 crown seats) were included. One-quarter of the procedures (47; 24.9%) required no local anesthesia. Of the 137 cases requiring anesthesia, 88 (64.2%) were managed with a single agent, 41 (29.9%) with dual agents, and 8 (5.8%) required an IANB. Overall, 129 of the 137 cases (94.2%) were successfully completed without IANB. The need for IANB was significantly associated with procedure type (P = 0.0008), occurring most frequently during crown preparations (7 of 57 cases, 12.3%). Conclusion The TNN anesthesia protocol achieved profound anesthesia in 94.2% of mandibular first molar cases without requiring IANB, demonstrating its effectiveness as a primary anesthetic strategy. Compared with traditional IANB, the TNN approach offers rapid-onset, site-specific anesthesia while reducing patient anesthetic exposure and postoperative complications. These findings support reframing IO anesthesia from a secondary “rescue” technique to an effective first-line modality. Prospective multicenter studies are warranted to validate its efficacy in broader patient populations.

Plastic bronchitis is a rare condition in which mucus plugs obstruct the bronchi, potentially leading to fatal respiratory failure. It has been reported in some patients with congenital heart disease following Fontan surgery.We report the general anesthesia management of a 22-year-old female patient with Fontan circulation and type II plastic bronchitis that was controlled using regular intravenous heparin injections. In this case, concerns existed regarding airway obstruction by bronchial plugs and hemodynamic instability specific to the Fontan circulation.During endotracheal intubation, the absence of mucus plugs was confirmed using a flexible bronchoscope.Intraoperatively, ventilation was managed at low pressure to avoid an increase in intrathoracic pressure caused by high positive-pressure ventilation. Additionally, fluid overload was avoided to prevent elevations in the central venous pressure. Consequently, perioperative management can be safely performed without any respiratory or circulatory complications. As treatment outcomes improve, the number of dental and oral surgical procedures in adult patients with congenital heart disease is expected to increase. Therefore, knowledge of congenital heart disease and its sequelae, such as plastic bronchitis, is essential to perform appropriate risk assessment and management.

Background: Although the relationship between gut bacteria and pain is increasingly well understood, research on the role of oral bacteria in pain remains limited. Porphyromonas gingivalis (P. gingivalis), a major pathogen in periodontal disease, is known to drive the progression of infection in the oral cavity, leading to inflammation and tissue destruction. However, unlike other conditions, patients with periodontal disease exhibit variable pain responses. This unique presentation suggests that P. gingivalis exerts multifaceted effects on pain modulation. Methods: The bibliographic databases of PubMed, Embase, Google Scholar, and the Cochrane Library were searched for original and reviewed in vitro, animal, and human studies. Key data on pain, inflammation, and neuroimmune pathways were extracted. Studies that did not address pain mechanisms or were limited to non-oral/systemic conditions without a clear link to orofacial pain were excluded. Results: This review summarizes the current evidence on how P. gingivalis influences inflammation and pain, highlighting the interactions between its cell wall components (e.g., lipopolysaccharide and fimbriae), metabolic byproducts (e.g., nitric oxide and butyric acid), and the host immune response. Conclusion The diverse pain manifestations in P. gingivalis-induced periodontitis may reflect the different stages of disease. Early pain suppression may result from bacterial immune evasion, wherein therapies adjunctive to scaling and root planing, such as host modulation therapy or gingipain inhibitors, may help restore host immunity and improve clinical outcomes.

Dominant dystrophic epidermolysis bullosa (DDEB) is a rare inherited skin disorder characterized by extreme fragility of the skin and mucosa that poses significant challenges for anesthetic management. Herein, we report a case of a 65-year-old woman with DDEB who underwent a 13-hour surgery for mandibular cancer under general anesthesia. To prevent skin and mucosal injuries, meticulous perioperative strategies were implemented, including the use of barrier films and pressure-relieving pads and avoiding adhesive devices. High-flow nasal cannula oxygenation enabled awake fiberoptic intubation without the need for mask ventilation, minimizing the risk of blister formation and airway trauma. Despite the prolonged duration, no pressure ulcers or new skin injuries developed, other than minor epidermal peeling of the lips. This case demonstrates that comprehensive preoperative planning and intraoperative protection can ensure safe anesthesia in patients with DDEB undergoing long surgical procedures.

Background: Dexmedetomidine (DEX) is an α₂-adrenergic agonist widely used for intravenous sedation. Its pharmacological properties suggest autonomic modulatory effects; however, these remain insufficiently characterized during operative procedures. This pilot study compared autonomic responses to surgical stress of DEX and propofol (PPF) during third molar extraction using the Analgesia Nociception Index (ANI), a heart rate variability-derived marker of autonomic balance. Methods Adults aged ≥18 years undergoing extraction of mandibular third molars under intravenous sedation were prospectively enrolled. Sedation was maintained with either DEX or PPF infusion following a small pre-induction dose of midazolam. ANI was continuously recorded using a High-Frequency Variability Index module, with a 240-s moving average considered equivalent to ANI. The primary outcome was the minimum ANI value within each predefined 5-min intraoperative interval; percent change from baseline (%Δ

Background: Bruxism has been widely discussed. The concepts of normobruxism and pathobruxism have recently been proposed. Severe pain in the masticatory muscles, which may be caused by pathobruxism, needs to be addressed. However, a clear causal relationship between bruxism and chronic pain in the masticatory muscles has not been elucidated. In addition, the effects of clenching and grinding on the body and their differences remain unclear. In particular, no studies have examined the effects of bruxism-like jaw movements on the peripheral tissues of the masticatory muscles and the autonomic nervous system.This study aimed to investigate the effects of bruxism on the masseter muscles and autonomic nervous system and to examine the differences between clenching and grinding. Methods: A total of 18 healthy volunteers, including 8 men (age: 31.3 ± 2.9 years) and 10 women (age: 28.9 ± 3.2 years) who had consented to participate in the study. We experimentally instructed them to clench and grind; measured the dynamic changes in oxygenation, electromyography, and heart rate variability (HRV); and assessed the subjective degree of fatigue. Results: Oxygenation, clenching, and tissue oxygen saturation (StO 2 ) and oxyhemoglobin (OxHb) levels decreased, whereas deoxygenated hemoglobin (dOxHb) levels increased. No change in grinding occurred; however, significant differences in muscle usage and subjective fatigue were observed between clenching and grinding. No significant differences were identified in HRV. Conclusions Tissue oxygenation differed significantly between clenching and grinding. Clenching resulted in a significant ischemic state, which rapidly recovered after clenching stopped. Grinding did not affect tissue oxygenation.

Background: Patients who report to be difficult to anesthetize for dental procedures are commonly encountered.Determining their frequency and shared characteristics could improve understanding of pain management failures. Methods: Categorical and continuous variables of 24 demographic, medical history, and dental history variables were compared in a deidentified cross-sectional study using electronic health records (EHR) of patients at the University of Iowa College of Dentistry. Individuals who self-reported to be difficult to anesthetize in their dental health history form were compared to those who reported no complications with local anesthesia. Descriptive, univariate regression, and multivariable regression statistical analyses were completed on the demographic, medical history, and dental history EHR variables. Results: A total of 12,400 deidentified patient records met the inclusion criteria with a 11.4% (n = 1,411) prevalence of difficult to anesthetize self-reports. Eight categorical variables were found to have statistically significant (95% confidence interval [CI]) adjusted odds ratios (AOR) in the multivariable regression of difficult to anesthetize reporting patients: female gender (AOR = 1.61, 95% CI: 1.32-1.96, P < 0.001), dental fear (AOR = 3.60, 95% CI: 3.01-4.31, P < 0.001), mental health disorders (AOR = 1.21, 95% CI: 1.00-1.46, P < 0.045), problems with general anesthesia (AOR = 1.46, 95% CI: 1.11-1.89, P = 0.005), neurologicalerve disorders (AOR = 1.30, 95% CI: 1.05-1.60, P = 0.015), temporomandibular joint clicking/popping (AOR = 1.31, 95% CI: 1.08-1.60, P = 0.006), needle anxiety (AOR = 29.03, 95% CI: 23.80-35.52, P < 0.001), and history of root canal treatment (AOR 0.82, 95% CI: 0.68-0.99, P = 0.035). Conclusion A clinically relevant percentage of patients self-reported being difficult to anesthetize for dental procedures. The relationship between local anesthesia inadequacies and variables such as female gender, dental fear, mental health, and neurological disorders requires further investigation. The use of evidence-based local anesthesia approaches and communication practices is suggested to minimize pain experienced and subsequent fear of dental care.