This study examined the relationship between pain severity, clinical findings, and endodontic disease by surveying 228 dental patients presenting with acute tooth pain. The study found that percussion sensitivity on adjacent healthy teeth strongly predicted higher pain levels, suggesting it detects central sensitization. Painful palpation was more common in teeth with previous treatment, while painful percussion was more common in teeth with pulp necrosis. Certain pain descriptors like throbbing and radiating pain were associated with mechanical hypersensitivity. Overall, the study suggests percussion and palpation tests detect different aspects of endodontic pathology and that pain is a complex phenomenon influenced by central sensitization processes.
Diagnosis and treatment planing of conservativeAjeet Kumar
This document provides an overview of patient evaluation, examination, diagnosis, and treatment planning for conservative and endodontic treatment. It discusses taking a thorough case history, medical history, and clinical examination including inspection, palpation, percussion, and exploration of the soft tissues, hard tissues, periodontal tissues, existing restorations, and use of radiographs and diagnostic tests to arrive at a diagnosis and treatment plan. The goal is to identify any dental or systemic issues, thoroughly examine the patient, and determine the appropriate treatment.
This prospective case series evaluated the effectiveness of ultrasound-guided trigeminal nerve blocks via the pterygopalatine fossa in 15 patients with unilateral facial pain refractory to medical and surgical treatments. All patients experienced complete sensory analgesia within 15 minutes and reported pain relief within 5 minutes. At follow-up over 15 months, the majority of patients maintained pain relief. No patients experienced side effects. The study concludes ultrasound-guided injections in the pterygopalatine fossa provide safe and effective long-term pain relief for refractory trigeminal neuralgia or atypical facial pain.
Diagnosis is defined as utilization of scientific knowledge for identifying a diseased process and to differentiate from other disease process
Literal meaning of diagnosis is determination and judgment of variations from the normal .
Epidemiology of Orofacial Pain in Population of Jammu City in India: An Origi...DrHeena tiwari
This study evaluated the etiology of orofacial pain among 400 patients visiting private clinics in Jammu, India. The results showed that dental caries leading to pulpitis was the most common cause of orofacial pain, affecting 96 patients. Periodontal disease and tooth sensitivity were also significant causes. Orofacial pain was more prevalent in females aged 26-35 years. The pain most commonly worsened during sleep and evenings and lasted less than 1 hour for many subjects. This study concluded that dental caries is the primary etiology of orofacial pain in this population and treatment should be tailored based on the identified cause.
This presentation explains the various controversies in different topics in periodontics. Discusses the controversies in Classification of periodontal diseases,
Diagnosis of periodontal diseases,
Prognosis,
Tooth mobility & splinting,
Gingival curettage one stage full-mouth disinfection versus quadrant SRP,
Systemic antimicrobials in periodontal therapy, Non-surgical versus surgical periodontal therapy,
Postsurgical antimicrobial medication,
Periodontal pack,
Periodontal-endodontic relationship,
Periodontal and systemic diseases,
Implant therapy in periodontally compromised patients.
Patient evaluation,diagnosis and treatment planing in conservativeVajid Kurikkal
The document discusses the diagnostic process in dentistry. It explains that diagnosis consists of four steps: assembling available facts, analyzing and interpreting clues to make a tentative diagnosis, making differential diagnoses of possible diseases, and selecting the closest possible choice. A thorough clinical history, examination, and diagnostic aids are needed to arrive at an accurate diagnosis and treatment plan. The diagnostic process involves assessing the chief complaint, medical history, clinical examination, and diagnostic tests and using this information to determine the nature of the illness.
Assessment of lingual nerve injury using different surgical variables for man...DrKamini Dadsena
This document summarizes a journal presentation on a clinical study assessing lingual nerve injury from mandibular third molar surgery. The study examined 1200 patients undergoing third molar removal and found an overall 5.6% temporary lingual nerve impairment rate and 0.3% permanent rate. Factors associated with higher temporary injury rates included lingual flap retraction, tooth sectioning, and buccal guttering. The presentation reviews the study methodology, results, comparisons to other studies, and discusses techniques to reduce lingual nerve injury risk during third molar surgery.
Diagnosis and treatment planing of conservativeAjeet Kumar
This document provides an overview of patient evaluation, examination, diagnosis, and treatment planning for conservative and endodontic treatment. It discusses taking a thorough case history, medical history, and clinical examination including inspection, palpation, percussion, and exploration of the soft tissues, hard tissues, periodontal tissues, existing restorations, and use of radiographs and diagnostic tests to arrive at a diagnosis and treatment plan. The goal is to identify any dental or systemic issues, thoroughly examine the patient, and determine the appropriate treatment.
This prospective case series evaluated the effectiveness of ultrasound-guided trigeminal nerve blocks via the pterygopalatine fossa in 15 patients with unilateral facial pain refractory to medical and surgical treatments. All patients experienced complete sensory analgesia within 15 minutes and reported pain relief within 5 minutes. At follow-up over 15 months, the majority of patients maintained pain relief. No patients experienced side effects. The study concludes ultrasound-guided injections in the pterygopalatine fossa provide safe and effective long-term pain relief for refractory trigeminal neuralgia or atypical facial pain.
Diagnosis is defined as utilization of scientific knowledge for identifying a diseased process and to differentiate from other disease process
Literal meaning of diagnosis is determination and judgment of variations from the normal .
Epidemiology of Orofacial Pain in Population of Jammu City in India: An Origi...DrHeena tiwari
This study evaluated the etiology of orofacial pain among 400 patients visiting private clinics in Jammu, India. The results showed that dental caries leading to pulpitis was the most common cause of orofacial pain, affecting 96 patients. Periodontal disease and tooth sensitivity were also significant causes. Orofacial pain was more prevalent in females aged 26-35 years. The pain most commonly worsened during sleep and evenings and lasted less than 1 hour for many subjects. This study concluded that dental caries is the primary etiology of orofacial pain in this population and treatment should be tailored based on the identified cause.
This presentation explains the various controversies in different topics in periodontics. Discusses the controversies in Classification of periodontal diseases,
Diagnosis of periodontal diseases,
Prognosis,
Tooth mobility & splinting,
Gingival curettage one stage full-mouth disinfection versus quadrant SRP,
Systemic antimicrobials in periodontal therapy, Non-surgical versus surgical periodontal therapy,
Postsurgical antimicrobial medication,
Periodontal pack,
Periodontal-endodontic relationship,
Periodontal and systemic diseases,
Implant therapy in periodontally compromised patients.
Patient evaluation,diagnosis and treatment planing in conservativeVajid Kurikkal
The document discusses the diagnostic process in dentistry. It explains that diagnosis consists of four steps: assembling available facts, analyzing and interpreting clues to make a tentative diagnosis, making differential diagnoses of possible diseases, and selecting the closest possible choice. A thorough clinical history, examination, and diagnostic aids are needed to arrive at an accurate diagnosis and treatment plan. The diagnostic process involves assessing the chief complaint, medical history, clinical examination, and diagnostic tests and using this information to determine the nature of the illness.
Assessment of lingual nerve injury using different surgical variables for man...DrKamini Dadsena
This document summarizes a journal presentation on a clinical study assessing lingual nerve injury from mandibular third molar surgery. The study examined 1200 patients undergoing third molar removal and found an overall 5.6% temporary lingual nerve impairment rate and 0.3% permanent rate. Factors associated with higher temporary injury rates included lingual flap retraction, tooth sectioning, and buccal guttering. The presentation reviews the study methodology, results, comparisons to other studies, and discusses techniques to reduce lingual nerve injury risk during third molar surgery.
Tratamentos efectivos para pacientes com um tamanho reduzido do pénisvacextensor
This document describes a pilot study that tested the efficacy and tolerability of a penile extender device called the Andro-Penis® in treating short penis. 15 patients were required to use the device for at least 4 hours per day for 6 months. Penile dimensions and erectile function were measured before and after treatment. After 6 months, patients experienced a statistically significant increase in flaccid and stretched penis length of 2.3 cm and 1.7 cm respectively, with no significant changes in girth. Patient satisfaction scores improved and were consistent with acceptable or good improvement in erectile function and penile size. The study concluded the penile extender is a minimally invasive and effective treatment to elongate the pen
Neural blockade for persistent pain after breast cancer surgery Jason Attaman
1) The review examined evidence for neural blockade as a diagnostic tool or treatment for persistent pain after breast cancer surgery.
2) Only 7 studies with a total of 135 patients were identified that used blocks targeting the stellate ganglion, paravertebral plexus, or intercostal nerves.
3) The quality of evidence from the studies was low and inconclusive about the efficacy of neural blockade for treating persistent pain after breast cancer surgery. More high-quality studies are needed to evaluate this common clinical problem.
Clinical effect and safety of pulsed radiofrequency treatment for pudendal ne...Jason Attaman
The document describes a prospective, randomized controlled clinical trial that compared the clinical effect and safety of pulsed radiofrequency (PRF) treatment combined with pudendal nerve block (NB) to NB alone for treating pudendal neuralgia. Eighty patients were randomly assigned to receive either PRF+NB or NB. Pain levels, depression scores, treatment effects, analgesic use, and adverse events were assessed over 3 months. The results showed that PRF+NB provided significantly greater pain relief and improved depression scores compared to NB alone, with no severe adverse events reported for either group.
Journal Club on A novel approach to the management of a central giant cell gr...Dr Bhavik Miyani
This journal club presentation summarizes a case report on the use of denosumab to treat central giant cell granuloma (CGCG) of the mandible. CGCG is an aggressive bone lesion with high recurrence rates following surgical treatment. The case report describes a patient who did not respond to intralesional steroids or calcitonin, but did experience resolution of symptoms and ossification of the lesion within 6 months of treatment with denosumab. A biopsy 18 months later found no residual CGCG. The presentation reviews current treatments for CGCG and the mechanism of action of denosumab, and concludes denosumab may be an effective alternative or adjunct to surgery.
Surgical v/s Non surgical periodontal therapy Achi Joshi
Both surgical and nonsurgical therapy produced improvement in the periodontal health.
Treatment approach was based on the comfort level of the practitioner.
In the late 60’s and continuing into the 70’s and 80’s, many series of longitudinal studies were conducted, aimed to document the immediate and most importantly long term clinical results following several types of periodontal therapy.
This document proposes a new clinical classification system for pulp diseases that is based on clinical findings rather than histopathological findings. It aims to avoid confusion caused by other classification systems that mix clinical and histological terminology. The proposed system recognizes clinically normal pulp as a diagnosis and classifies pulp diseases as progressing through stages of inflammation, necrosis, infection, and pulpless canals. It is intended to help clinicians understand disease processes and direct appropriate conservative treatment.
The use of pulsed radiofrequency for the treatment of pudendal neuralgia a c...Jason Attaman
This study evaluated the use of pulsed radiofrequency (PRF) for treating pudendal neuralgia in 7 patients. PRF is a minimally invasive technique that uses radiofrequency energy to modulate nerves without damaging tissue. The average number of PRF treatments was 4.4, and the average duration of pain relief was 11.4 weeks. There were no complications reported. The study concludes that PRF may be an effective and safe treatment for pudendal neuralgia in patients where conservative treatments have not provided adequate relief, but larger controlled studies are still needed.
This document outlines the phases of periodontal therapy, including:
1) Preliminary phase focusing on emergencies and extractions.
2) Nonsurgical phase involving plaque control, non-surgical treatments like scaling and root planing.
3) Surgical phase using various periodontal surgeries and other treatments like implants and endodontics.
4) Restorative phase for final restorations and prosthodontics.
5) Maintenance phase for long-term supportive periodontal therapy.
Surgical periodontal therapy aims to eliminate pathologic changes, create a stable periodontium, and promote regeneration through techniques like pocket reduction surgeries and correction of anatomic defects
Pharmacist Educational Intervention in Intravenous Patient Controlled Analges...Sunil Vadithya
Pharmacist Educational Intervention in Intravenous Patient Controlled Analgesia is Associated with Decreased Postoperative PainPharmacist Educational Intervention in Intravenous Patient Controlled Analgesia is Associated with Decreased Postoperative Pain
The document discusses supportive periodontal therapy (SPT). It defines SPT as therapeutic measures needed to support a patient's efforts to control periodontal infections and avoid reinfection. The document outlines the rationale for SPT, noting that no definitive periodontal treatment exists and continuous monitoring and treatment is needed to prevent disease recurrence. It describes patients susceptible to periodontitis as being at high risk of reinfection and progression without SPT. Regular SPT including subgingival scaling is important for long-term benefits of periodontal treatment.
Periodontal disease requires ongoing supportive periodontal therapy (SPT) to maintain dental health. SPT involves regular professional cleanings and assessments to monitor risk factors and disease progression. The goals of SPT are to prevent recurrence of periodontal disease, reduce tooth loss, and catch other oral issues early. SPT assessments evaluate patient, tooth, and site-specific risks. Patients deemed high risk based on factors like bleeding, pockets, tooth loss, and smoking require more frequent preventive care. SPT aims to control inflammation through ongoing plaque removal to keep gingivitis and periodontitis at bay.
This document provides an introduction to a book on prosthodontic treatment of patients presented by the Graduate Program in Oral Rehabilitation at the Hebrew University-Hadassah School of Dental Medicine in Jerusalem, Israel. The book is divided into four parts based on the primary problem of each patient: periodontal breakdown, dysfunctional habits, extensive tooth loss, and congenital disorders. The basis for all prosthodontic treatment is a healthy periodontium. The goal is to identify the etiology of each patient's condition and develop a comprehensive treatment plan tailored to the individual patient.
The document discusses the process of diagnosis in operative dentistry. It explains that diagnosis involves taking a chief complaint, medical history, dental history, and conducting a clinical examination. The examination includes extraoral and intraoral soft tissue exams, examining the dentition for issues, and tests like percussion, palpation, radiographs, and pulp vitality tests. Pulp vitality tests help determine the response to stimuli and identify teeth with abnormal responses. The document outlines various thermal, electric, and other specialized tests that can be used in diagnosing and determining pulp vitality.
The document describes a clinical trial that assessed the effects of using a Connecticut intrusion arch (CIA) with or without a distal bend on maxillary incisor and molar positions. 44 patients were randomly divided into two groups: one treated with a CIA without a distal bend, and one treated with a CIA with a distal bend. Cephalometric analysis found that the group without a distal bend experienced labial flaring and proclination of maxillary incisors, while the group with a distal bend experienced palatal inclination and retroclination of maxillary incisors. No significant differences were found between the groups for maxillary molar positions. The presence or absence of a distal bend in the CIA affects incis
This seminar explains various periodontal risk assessment tools at subject, tooth and site level risk assessment. Also, SPT with adjunct use of antimicrobials by professional and to be used by personals. Maintenance care for the implant patients has also been described with different conditions. The role played by dentist and by patient is being explained in flowcharts. And at last complications during SPT is described with references.
This document discusses supportive periodontal therapy (SPT). It begins with an introduction and overview of SPT. It then discusses the rationale and objectives of SPT, which include preventing disease recurrence and progression. Compliance is important for effective SPT. The document outlines the typical parts of an SPT visit, including examination, motivation and instrumentation, treatment of reinfected sites, and determination of recall interval. Research shows that regular SPT every 3-6 months is effective at preventing further attachment and bone loss. The document also discusses classifying post-treatment patients, referring patients to specialists, assessing risk of disease recurrence, and complications of SPT.
This document summarizes the condition known as Ménière's disease. It describes the typical symptoms including vertigo, tinnitus, and hearing loss. It discusses the diagnostic criteria and notes the disease is associated with endolymphatic hydrops, though the cause is unknown. It reviews treatment options including medications, surgery, and lifestyle modifications. It provides background on Prosper Ménière, the French physician who first identified and described the condition in 1861.
This document discusses factors to consider for case selection in endodontic treatment. Proper case selection is important to ensure successful treatment outcomes and avoid pitfalls. Key factors include those related to the tooth itself like root canal anatomy, restorability, and periodontal support. Patient health factors like medical history and physical status must also be evaluated. The clinician's skill and ability to handle different cases is another important consideration. Careful evaluation of all relevant factors helps determine if endodontic therapy is appropriate and predicts the difficulty level of the case.
Relief of urinary urgency, hesitancy, and male pelvic pain with pulsed radiof...Jason Attaman
This document summarizes a case report of a 86-year-old man who underwent pulsed radiofrequency ablation (RFA) of the pudendal nerve to treat urinary urgency, hesitancy, and pelvic pain. The patient had a 30-year history of urinary symptoms and had tried various medications and procedures without success. After undergoing pulsed RFA of the pudendal nerve, the patient reported marked improvement in his pelvic pain and a significant reduction in his urinary symptoms. The summary concludes that pudendal nerve block with pulsed RFA may be an effective treatment for pelvic pain and urinary symptoms.
Supportive periodontal therapy (SPT) involves long-term maintenance programs following active periodontal treatment to maintain periodontal health. SPT involves periodic examination, motivation and instrumentation of sites showing inflammation, treatment of reinfected sites, and polishing. It begins after active treatment and is aimed at preventing recurrence through early detection of disease. The frequency of SPT visits depends on the patient's periodontal risk assessment but generally occurs every 3-4 months. It can be performed by general dentists or specialists depending on the extent of original periodontal destruction. Adjunctive use of antimicrobials may also be included in SPT.
2013 Toronto Academy of Dentistry, 76th Annual Winter Clinic
New Approaches in Management of Endodontic Pain by
Dr. Pavel S. Cherkas, Endodontist-Neuroscientist and
Dr. Ruslan Dorfman, Molecular Geneticist
Tratamentos efectivos para pacientes com um tamanho reduzido do pénisvacextensor
This document describes a pilot study that tested the efficacy and tolerability of a penile extender device called the Andro-Penis® in treating short penis. 15 patients were required to use the device for at least 4 hours per day for 6 months. Penile dimensions and erectile function were measured before and after treatment. After 6 months, patients experienced a statistically significant increase in flaccid and stretched penis length of 2.3 cm and 1.7 cm respectively, with no significant changes in girth. Patient satisfaction scores improved and were consistent with acceptable or good improvement in erectile function and penile size. The study concluded the penile extender is a minimally invasive and effective treatment to elongate the pen
Neural blockade for persistent pain after breast cancer surgery Jason Attaman
1) The review examined evidence for neural blockade as a diagnostic tool or treatment for persistent pain after breast cancer surgery.
2) Only 7 studies with a total of 135 patients were identified that used blocks targeting the stellate ganglion, paravertebral plexus, or intercostal nerves.
3) The quality of evidence from the studies was low and inconclusive about the efficacy of neural blockade for treating persistent pain after breast cancer surgery. More high-quality studies are needed to evaluate this common clinical problem.
Clinical effect and safety of pulsed radiofrequency treatment for pudendal ne...Jason Attaman
The document describes a prospective, randomized controlled clinical trial that compared the clinical effect and safety of pulsed radiofrequency (PRF) treatment combined with pudendal nerve block (NB) to NB alone for treating pudendal neuralgia. Eighty patients were randomly assigned to receive either PRF+NB or NB. Pain levels, depression scores, treatment effects, analgesic use, and adverse events were assessed over 3 months. The results showed that PRF+NB provided significantly greater pain relief and improved depression scores compared to NB alone, with no severe adverse events reported for either group.
Journal Club on A novel approach to the management of a central giant cell gr...Dr Bhavik Miyani
This journal club presentation summarizes a case report on the use of denosumab to treat central giant cell granuloma (CGCG) of the mandible. CGCG is an aggressive bone lesion with high recurrence rates following surgical treatment. The case report describes a patient who did not respond to intralesional steroids or calcitonin, but did experience resolution of symptoms and ossification of the lesion within 6 months of treatment with denosumab. A biopsy 18 months later found no residual CGCG. The presentation reviews current treatments for CGCG and the mechanism of action of denosumab, and concludes denosumab may be an effective alternative or adjunct to surgery.
Surgical v/s Non surgical periodontal therapy Achi Joshi
Both surgical and nonsurgical therapy produced improvement in the periodontal health.
Treatment approach was based on the comfort level of the practitioner.
In the late 60’s and continuing into the 70’s and 80’s, many series of longitudinal studies were conducted, aimed to document the immediate and most importantly long term clinical results following several types of periodontal therapy.
This document proposes a new clinical classification system for pulp diseases that is based on clinical findings rather than histopathological findings. It aims to avoid confusion caused by other classification systems that mix clinical and histological terminology. The proposed system recognizes clinically normal pulp as a diagnosis and classifies pulp diseases as progressing through stages of inflammation, necrosis, infection, and pulpless canals. It is intended to help clinicians understand disease processes and direct appropriate conservative treatment.
The use of pulsed radiofrequency for the treatment of pudendal neuralgia a c...Jason Attaman
This study evaluated the use of pulsed radiofrequency (PRF) for treating pudendal neuralgia in 7 patients. PRF is a minimally invasive technique that uses radiofrequency energy to modulate nerves without damaging tissue. The average number of PRF treatments was 4.4, and the average duration of pain relief was 11.4 weeks. There were no complications reported. The study concludes that PRF may be an effective and safe treatment for pudendal neuralgia in patients where conservative treatments have not provided adequate relief, but larger controlled studies are still needed.
This document outlines the phases of periodontal therapy, including:
1) Preliminary phase focusing on emergencies and extractions.
2) Nonsurgical phase involving plaque control, non-surgical treatments like scaling and root planing.
3) Surgical phase using various periodontal surgeries and other treatments like implants and endodontics.
4) Restorative phase for final restorations and prosthodontics.
5) Maintenance phase for long-term supportive periodontal therapy.
Surgical periodontal therapy aims to eliminate pathologic changes, create a stable periodontium, and promote regeneration through techniques like pocket reduction surgeries and correction of anatomic defects
Pharmacist Educational Intervention in Intravenous Patient Controlled Analges...Sunil Vadithya
Pharmacist Educational Intervention in Intravenous Patient Controlled Analgesia is Associated with Decreased Postoperative PainPharmacist Educational Intervention in Intravenous Patient Controlled Analgesia is Associated with Decreased Postoperative Pain
The document discusses supportive periodontal therapy (SPT). It defines SPT as therapeutic measures needed to support a patient's efforts to control periodontal infections and avoid reinfection. The document outlines the rationale for SPT, noting that no definitive periodontal treatment exists and continuous monitoring and treatment is needed to prevent disease recurrence. It describes patients susceptible to periodontitis as being at high risk of reinfection and progression without SPT. Regular SPT including subgingival scaling is important for long-term benefits of periodontal treatment.
Periodontal disease requires ongoing supportive periodontal therapy (SPT) to maintain dental health. SPT involves regular professional cleanings and assessments to monitor risk factors and disease progression. The goals of SPT are to prevent recurrence of periodontal disease, reduce tooth loss, and catch other oral issues early. SPT assessments evaluate patient, tooth, and site-specific risks. Patients deemed high risk based on factors like bleeding, pockets, tooth loss, and smoking require more frequent preventive care. SPT aims to control inflammation through ongoing plaque removal to keep gingivitis and periodontitis at bay.
This document provides an introduction to a book on prosthodontic treatment of patients presented by the Graduate Program in Oral Rehabilitation at the Hebrew University-Hadassah School of Dental Medicine in Jerusalem, Israel. The book is divided into four parts based on the primary problem of each patient: periodontal breakdown, dysfunctional habits, extensive tooth loss, and congenital disorders. The basis for all prosthodontic treatment is a healthy periodontium. The goal is to identify the etiology of each patient's condition and develop a comprehensive treatment plan tailored to the individual patient.
The document discusses the process of diagnosis in operative dentistry. It explains that diagnosis involves taking a chief complaint, medical history, dental history, and conducting a clinical examination. The examination includes extraoral and intraoral soft tissue exams, examining the dentition for issues, and tests like percussion, palpation, radiographs, and pulp vitality tests. Pulp vitality tests help determine the response to stimuli and identify teeth with abnormal responses. The document outlines various thermal, electric, and other specialized tests that can be used in diagnosing and determining pulp vitality.
The document describes a clinical trial that assessed the effects of using a Connecticut intrusion arch (CIA) with or without a distal bend on maxillary incisor and molar positions. 44 patients were randomly divided into two groups: one treated with a CIA without a distal bend, and one treated with a CIA with a distal bend. Cephalometric analysis found that the group without a distal bend experienced labial flaring and proclination of maxillary incisors, while the group with a distal bend experienced palatal inclination and retroclination of maxillary incisors. No significant differences were found between the groups for maxillary molar positions. The presence or absence of a distal bend in the CIA affects incis
This seminar explains various periodontal risk assessment tools at subject, tooth and site level risk assessment. Also, SPT with adjunct use of antimicrobials by professional and to be used by personals. Maintenance care for the implant patients has also been described with different conditions. The role played by dentist and by patient is being explained in flowcharts. And at last complications during SPT is described with references.
This document discusses supportive periodontal therapy (SPT). It begins with an introduction and overview of SPT. It then discusses the rationale and objectives of SPT, which include preventing disease recurrence and progression. Compliance is important for effective SPT. The document outlines the typical parts of an SPT visit, including examination, motivation and instrumentation, treatment of reinfected sites, and determination of recall interval. Research shows that regular SPT every 3-6 months is effective at preventing further attachment and bone loss. The document also discusses classifying post-treatment patients, referring patients to specialists, assessing risk of disease recurrence, and complications of SPT.
This document summarizes the condition known as Ménière's disease. It describes the typical symptoms including vertigo, tinnitus, and hearing loss. It discusses the diagnostic criteria and notes the disease is associated with endolymphatic hydrops, though the cause is unknown. It reviews treatment options including medications, surgery, and lifestyle modifications. It provides background on Prosper Ménière, the French physician who first identified and described the condition in 1861.
This document discusses factors to consider for case selection in endodontic treatment. Proper case selection is important to ensure successful treatment outcomes and avoid pitfalls. Key factors include those related to the tooth itself like root canal anatomy, restorability, and periodontal support. Patient health factors like medical history and physical status must also be evaluated. The clinician's skill and ability to handle different cases is another important consideration. Careful evaluation of all relevant factors helps determine if endodontic therapy is appropriate and predicts the difficulty level of the case.
Relief of urinary urgency, hesitancy, and male pelvic pain with pulsed radiof...Jason Attaman
This document summarizes a case report of a 86-year-old man who underwent pulsed radiofrequency ablation (RFA) of the pudendal nerve to treat urinary urgency, hesitancy, and pelvic pain. The patient had a 30-year history of urinary symptoms and had tried various medications and procedures without success. After undergoing pulsed RFA of the pudendal nerve, the patient reported marked improvement in his pelvic pain and a significant reduction in his urinary symptoms. The summary concludes that pudendal nerve block with pulsed RFA may be an effective treatment for pelvic pain and urinary symptoms.
Supportive periodontal therapy (SPT) involves long-term maintenance programs following active periodontal treatment to maintain periodontal health. SPT involves periodic examination, motivation and instrumentation of sites showing inflammation, treatment of reinfected sites, and polishing. It begins after active treatment and is aimed at preventing recurrence through early detection of disease. The frequency of SPT visits depends on the patient's periodontal risk assessment but generally occurs every 3-4 months. It can be performed by general dentists or specialists depending on the extent of original periodontal destruction. Adjunctive use of antimicrobials may also be included in SPT.
2013 Toronto Academy of Dentistry, 76th Annual Winter Clinic
New Approaches in Management of Endodontic Pain by
Dr. Pavel S. Cherkas, Endodontist-Neuroscientist and
Dr. Ruslan Dorfman, Molecular Geneticist
The document discusses oro-facial pain and its management. It describes various types of dental pain, including short, sharp shooting pain which can be caused by conditions that expose dentin like caries, fractures, or gum recession. Tests that can help diagnose dental pain are discussed, like pulp sensitivity tests, percussion, probing, mobility and palpation. Radiographs may also reveal issues like recurrent decay or bone loss. The goal of acute pain management is to inhibit tissue damage signaling, block nerve impulses, and activate endogenous analgesia.
Diagnosis and treatment planing in EndodonticsSalem Rekab
This document provides an overview of endodontic diagnosis and treatment planning. It discusses the importance of gathering a chief complaint, health history, dental history, and conducting a subjective and objective examination of the patient. The subjective examination involves questioning the patient about their symptoms such as the intensity, spontaneity, and persistence of any pain. The objective examination includes extraoral and intraoral soft tissue exams, examining the dentition, and performing clinical tests like percussion, palpation, and pulp vitality tests using heat, cold, or electricity. Together, the subjective and objective exams allow the clinician to make a tentative diagnosis which is then confirmed through further examination and testing.
Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. It is initiated by specialized nerve endings called nociceptors and transmitted by neurons. There are four processes involved in pain: transduction, transmission, modulation, and perception. Pain can be classified as nociceptive (resulting from tissue damage) or neuropathic (resulting from damage or disease affecting the nervous system). A thorough history and clinical/radiographic examination is needed to diagnose the source and type of pain. Common sources of dental pain include pulpal and periapical diseases, periodontal diseases, fractures, cysts, and tumors. Non-dental sources can also mimic dental pain and should be considered.
Management of tmd symptoms with photobiomodulation therapyNishu Priya
Conservative approaches, such as soft diets, anti-inflammatory drugs and photobiomodulation therapy (PBMT) or low-level laser therapy (LLLT), have been used to manage TMD.
Lasers have proven to be successful in clinical settings and treatments of soft tissues, musculoskeletal pain, bone regeneration, dentinal hypersensitivity, and provide reduction in symptoms and improved function.
The mechanism of action in PBMT is via absorption of light, with deeply penetrating wavelengths ranging from 630 nm to 1300 nm, to stimulate tissues with direct irradiation to achieve analgesic and anti-inflammatory effects.
The output energy in PBMT does not affect skin temperature and is classified as a soft laser, which increases lymphatic flow, reduces edema and prostaglandin E2 (PGE2) and cyclooxygenase (COX) levels.
A systematic review for pain management reported placebo vs LLLT for practical and clinically relevant parameters using 700nm to 1200nm.
Here I present to you the basic concept and definition of endodontic diagnosis and treatment planning. It is presented to the level of mind of undergraduate students.
examination of temporomandibular joint disorders in orthodontic patientsMaher Fouda
This document discusses the examination of temporomandibular disorders in orthodontic patients. It begins by reviewing past assumptions that orthodontic treatment could cause TMD issues but notes that most scientific studies do not confirm these assumptions. The document then outlines the process for examining TMD in orthodontic patients, including taking a thorough patient history and conducting a physical examination of the temporomandibular joints and muscles. The goal of the examination is to identify any TMD issues before beginning orthodontic treatment and make appropriate referrals if needed.
The document provides information on the process of endodontic diagnosis. It discusses the importance of diagnosis and outlines the key stages: collecting patient information, questioning the patient, performing clinical tests, correlating findings, and formulating a diagnosis. A thorough clinical examination involves inspecting and palpating extraorally and intraorally, as well as examining tooth mobility, percussion, and periodontal probing to evaluate any signs of infection or pathology. The neurophysiology of dental pulp and pain transmission pathways are also summarized. The goal of diagnosis is to determine the nature of any dental disease by comprehensively gathering subjective and objective clinical findings.
The document discusses examination, diagnosis, and treatment planning in endodontics. It covers various diagnostic tests and procedures used to examine the teeth and surrounding tissues, such as extraoral and intraoral examination, palpation, percussion, mobility testing, periodontal examination, and various pulp tests. It also discusses examining symptoms and medical history, classifying pulpal and periapical diseases, and the importance of radiographic examination in endodontic diagnosis and treatment planning.
The document discusses the process of diagnosis in endodontics. It emphasizes that an accurate diagnosis requires synthesizing information from the patient's history, clinical examination findings, radiographs, and pulp testing results. The diagnostic process involves assembling available facts, interpreting clues to discover genuine factors in the case, generating a differential diagnosis, and reaching a working diagnosis. A proper diagnosis relies on the chief complaint as well as objective findings from visual examination, percussion, palpation, periodontal probing, and radiographs to assess pulpal and periapical tissues.
This document discusses diagnosis in endodontics. It begins by defining diagnosis as identifying a disease through investigation of symptoms and history. An accurate diagnosis requires synthesizing knowledge, experience, intuition and common sense. The diagnostic process involves assembling available facts, interpreting clues, making a differential diagnosis, and determining a working diagnosis. Key parts of diagnosis include understanding the chief complaint, performing clinical and radiographic examinations, and comparing findings to known conditions to determine the operational diagnosis. Diagnosis is crucial for developing an appropriate treatment plan.
Dr. Anton de Wijer is a specialist in special dental care, TMD and orofacial pain at the UMC St Radboud in the Netherlands. His practice focuses on treating temporomandibular disorders (TMD) using a multidisciplinary approach involving psychologists, manual therapists, dentists and other specialists. The document provides statistics on patients seen in his practice, describes the multidisciplinary treatment approach used at his clinic, and discusses the links between TMD and neck pain based on current research findings.
CONSIST OF INDTRODUCTION, PAIN DEFINITION , MECHANISM OF PAIN, THEORIES OF PAIN, PATHOPHYSIOLOGY OF PAIN, THORIES OF DENTIN HYPERSENSTIVITY , TREATMENT
Assessment and diagnosis of pain in dental practiceDr. Sreelekshmi J
This document provides information on assessing and diagnosing dental pain. It defines pain and diagnosis, describes the trigeminal nerve pathway for facial pain sensation, and outlines the examination process for a patient in pain. This includes reviewing history, performing clinical tests like pulp sensitivity tests, and considering diagnostic tests and images. Common sources of dental pain are also explained such as pulpal and periapical issues, cracked teeth, temporomandibular disorders, sinusitis, and post-endodontic surgery pain.
The document discusses diagnostic procedures used in dentistry. It outlines various tests like thermal tests, electric pulp tests, mobility tests, and radiographs that are used to diagnose dental issues like pulp vitality, periapical lesions, and periodontal disease. The goal of diagnosis is to accurately identify the disease through signs, symptoms, and test results to determine the appropriate treatment.
An overview of the diagnostic process in endodontics, including information about the pain system, referred pain, non-odontogenic pain, the diagnostic process, tests and treatment planning in endodontics.
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The document discusses the management of endodontic pain. It defines pain and describes the various causes of pre-treatment, during treatment, and post-treatment endodontic pain. It outlines strategies for diagnosing the source of pain and discusses both pharmacological and non-pharmacological options for managing different types of endodontic pain, including the use of analgesics, local anesthetics, antibiotics, and steroids. Challenges in achieving pulpal anesthesia for teeth with irreversible pulpitis ("hot tooth") are also covered, along with strategies for improving anesthesia success.
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Associations between Pain Severity, Clinical Findings, and Endodontic Disease: A Cross-Sectional Study
1. Associations between Pain Severity,
Clinical Findings, and Endodontic
Disease: A Cross-Sectional Study
Erdogan O, Malek M, Gibbs JL.
J Endod. 2021 Sep;47(9):1376-1382.
Presented by
Dr Nadeem Aashiq
MDS 2nd year
2. INTRODUCTION
• Dental pulp is elegantly confined within enamel and dentin. Similarly, the
teeth are confined within the periodontal ligament and alveolar bone.
• Therefore, it is very challenging to assess the true status of endodontic
pathology, including that of the pulp and the periapical tissues, during
diagnosis.
• Endodontic disease, either when the pulp is severely inflamed or when it
becomes necrotic, can produce severe pain or patients can present with
very advanced disease without any history of painful symptoms.
• Therefore, a thorough and careful assessment of how pain relates to other
clinical findings can provide valuable insight toward better inferring the
degree of pulpal and periapical inflammation and infection.
3. • After acquiring the detailed pain history, surrogate test like cold, thermal tests
and mechanical are critical for assessment for periapical and pulpal diagnosis.
• Cold sensibility testing is a reliable diagnostic tool with high specificity and
sensitivity to differentiate vital from necrotic pulp.
• On the other hand, the diagnostic utility of mechanical sensory testing,
including percussion, palpation, and the bite test, is less clear.
• An abnormal or painful response to mechanical sensory testing could be due to
inflammation or infection of the periapical tissues, and indeed this is the
common interpretation.
• However, it is also possible that percussion hypersensitivity may be detecting
peripheral and central sensitization–induced mechanical allodynia, originating
from inflamed and hypersensitive pulpal neuronal afferents, while the
periapical tissues remain free of any pathology
4. MATERIALS AND METHODS
• Patients who visited emergency dental clinics due to dental pain with at
least 3 out of 10 intensity on a numeric rating scale (NRS) were included in
the study.
• Also, there had to be a clear endodontic pathology localized to a single
tooth. Patients were excluded if there was another suspected source of
chronic or acute orofacial pain.
• We verbally administered a questionnaire and collected patients’
demographic information and pain history. Patients’ current pain intensity
was asked on an NRS between 0 and 10.
5. • Calibrated study personnel, who were either endodontic faculty or
endodontic residents, performed standardized endodontic diagnostic testing
procedures, including a cold test and mechanical sensory testing (bite,
percussion, and palpation).
• For each test, first, a healthy intact contralateral tooth and a healthy intact
adjacent tooth followed by the causative tooth in question were evaluated.
• For each test, the unpleasantness of the sensation was rated from 1 to 3,
with 1 being not or mildly unpleasant, 2 moderately unpleasant, and 3
severely unpleasant.
• For analysis, this result was scored as either non painful (score of 1) or
painful (score of 2 or 3; i.e., hypersensitive) percussion.
• Periapical pathology and the presence of any visible swelling were also
recorded. The pulpal and periapical diagnosis were ultimately determined by
2 endodontic faculty members using the American Association of
Endodontists guidelines.
6. RESULTS
• The study sample consisted of 228 subjects who attended a dental
emergency clinic due to dental pain.
• The mean age was 41 years, and 53% of the cohort were females. The
most common etiology of endodontic disease was caries (57%). The most
common pulpal diagnosis were irreversible pulpitis (IP) (34%) followed by
pulp necrosis (36%).
• The most common periapical diagnosis were symptomatic apical
periodontitis (67%) followed by acute apical abscess (14%). The average
pain intensity at the time of the evaluation was 5.2 on the NRS, and 72%
reported using some type of medication for pain relief.
7. Prediction of Acute Endodontic Pain: Univariate
Analysis
• Based on a univariate analysis, female patients and those below the age of
50 years, when presenting for an urgent endodontic visit, reported higher
intensity overall pain.
• Also, patients who described the temporal nature of their pain as variable
or constant pain (variable pain, constant pain but pain type and intensity
change over time; constant pain, pain that remains constant over time) as
opposed to intermittent pain (pain that comes and goes with some
periods with no pain) reported significantly higher pain levels (P , .05).
• Interestingly, patients with existing chronic pain conditions did not report
higher intensity pain levels
8. • We then determined the association between clinical testing and
examination findings and the intensity of pain. Patients who had a tooth
that responded to cold stimulation reported less severe pain intensity than
those with a negative response.
• Patients who reported moderate or severe pain to the percussion
hypersensitivity or palpation hypersensitivity test on the causative tooth or
the adjacent tooth and those who had swelling on clinical examination also
had higher levels of overall pain.
• Percussion and palpation hypersensitivity on the adjacent tooth showed
the strongest association with higher pain intensity reporting. The
presence of a periapical radiolucency was not associated with higher pain
intensity
9. Prediction of Acute Endodontic Pain: Multiple
Regression Analysis
• In order to better understand the relative contribution of predictors identified in the
univariate analysis to pain intensity, 2 consecutive multivariate regression models
were constructed .
• We found that age and sex were not predictors of preoperative pain intensity in
regression models. However, we should acknowledge the observable trend for
females to have higher pain intensity, even though it was not statistically significant .
• In the first model, in line with the univariate analysis, we found that patients with a
positive cold response reported less severe pain.
• On the other hand, painful palpation hypersensitivity did not predict higher pain
intensity as was observed with the univariate analysis. In the second model,
percussion hypersensitivity on the adjacent tooth was a strong predictor of higher
pain intensity.
• These results point out that percussion hypersensitivity on the healthy adjacent
tooth strongly predicted higher acute endodontic pain intensity, whereas palpation
hypersensitivity on the causative tooth did not predict higher pain intensity.
10. Associations between Mechanical Sensory Testing and
Pulpal Diagnosis
• We next evaluated the frequency of reporting of painful response to different
mechanical sensory tests in teeth with varying pulpal diagnoses to investigate
what these tests might capture about endodontic disease.
• We found that a painful response to percussion was frequently observed in
teeth with IP (64%), necrotic pulp (91%), and previously initiated/ treated teeth
(PIT) (68%). A subgroup analysis with Bonferroni adjustment (P 5 .017)
determined that painful percussion was more frequently reported by patients
diagnosed with pulpal necrosis compared with PIT and IP.
• The frequency of reporting of painful percussion on the adjacent tooth was
equally frequent in these 3 groups (IP: 30%, necrotic pulp: 33%, and PIT: 32%).
Variability was also observed in the frequency of observing painful palpation in
teeth with different pulpal diagnoses (IP: 36%, necrotic pulp: 58%, and PIT: 79%).
11. • Unlike percussion, painful palpation was more frequently reported by patients
diagnosed with PIT compared with both necrotic pulp and IP. Painful palpation
was more frequently reported by patients diagnosed with necrotic pulp
compared with IP.
• Finally, to better understand these findings, we investigated whether the
frequency of percussion and palpation pain in the necrotic pulp and PIT groups
could berelated to unequal distribution of teeth with frank periapical pathology
in these groups.
• To assess this, we looked at the frequencies of swelling and periapical
radiolucencies in these groups. Again, with a subgroup analysis with a Bonferroni
adjustment (P 5 .025), we found there was no difference in the frequency of the
presence of periapical radiolucency and swelling between these 2 groups.
• Therefore, the variation in frequencies of painful percussion and palpation in
teeth with pulpal necrosis or previously initiated/treated pulpal status were not
because of an unequal distribution of teeth with swelling and periapical
radiolucency in these groups.
12. DISCUSSION
• In endodontics, the relationship between the underlying pathophysiology of the
endodontic condition and the experience of pain is not well understood.
• Investigating this relationship can provide insight into the biological processes
underlying endodontic disease. In this study, we found that the presence of
periapical radiolucency was not associated with pain, whereas subjects with
swelling and/or a negative response to cold testing reported higher levels of pain.
• It has been reported that who have emergency endodontic treatment,
symptomatic pulpitis and symptomatic necrotic cases reported similar pain levels.
• On the other hand, both of these studies also reported that patients who were
diagnosed with symptomatic pulpitis were able to wait longer than patients who
were diagnosed with symptomatic necrotic teeth before seeking treatment.
suggesting that pain became less tolerable more often in necrotic cases.
13. • In clinical practice, we often use mechanical sensory testing including percussion,
palpation, and bite hypersensitivity testing. However, previous studies have
challenged the sensitivity and specificity of these tests, especially percussion
hypersensitivity, to differentiate the degree or the presence of endodontic disease.
• We found that in a multiple regression analysis, although a painful response to
palpation did not predict higher levels of pain, a painful response to percussion on
the adjacent healthy tooth was highly predictive of higher acute pain intensity.
• To evaluate further, we looked at the frequency of identifying painful percussion
and palpation with different pulpal diagnoses. Interestingly, painful percussion was
reported by the majority of patients who had necrotic pulp, whereas painful
palpation was more frequently reported by patients who had PIT, even though
there was no difference in the frequency of swelling or periapical radiolucency in
these 2 groups.
• These findings suggest that percussion and palpation testing may be capturing
different aspects of endodontic pathology.
14. • It has been proposed that percussion hypersensitivity, especially in teeth with vital
pulp, may actually reflect peripheral or central sensitization rather than indicating
inflammation of the periapical tissues.
• This study demonstrated that painful percussion on the healthy adjacent tooth was
a strong predictor of higher overall levels of pain. It is likely that pain on the
adjacent tooth represents central sensitization because it is coming from a non
affected site.
• We also found that reports of painful percussion on the adjacent tooth were
equally present in groups diagnosed with IP, pulp necrosis, and PIT Interestingly, in
all 3 of these groups, about one third of the patients reported that percussion on
the adjacent tooth was painful.
• We found that in the univariate analysis, females reported higher levels of pain.
Although not statistically significant, when modeled in multiple regression analysis,
females seemed to report higher acute endodontic pain, which is in line with the
literature reporting that females experience more severe pain.
15. • Moreover, we found that age did not predict preoperative pain. A previous
report found that pain intensity is inversely proportionate with age when
teeth with vital pulp were tested.
• The difference could be due to the fact that in our study population, only
about half of the cases had vital pulp. In addition, in this study, chronic pain
did not predict higher levels of preoperative pain, although it is generally
accepted that sensitization of the pain modulation system due to chronic
pain increases acute pain severity.
• The reason why age, sex, and the presence of chronic pain did not
unequivocally predict higher levels of odontalgia could be due to the
characteristics of the study population.
• It could also be due to unique features of endodontic pain; when pain due to
either pulpal inflammation or endodontic infection is severe enough to make
an emergency dental visit, factors such as sex, age, and the presence of
chronic pain may not so clearly influence the degree of pain experienced.
16. • First, there was the potential variability in the performance of clinical
testing in the study. In order to minimize provider variability, study
personnel were trained and calibrated, and patients were given a visual
scale to help specify their responses more accurately. However, because
pain reporting is inherently variable, there certainly was variability in
patient responses to mechanical testing.
• Another limitation of the study is that pulp vitality was inferred by vitality
(cold) tests instead of a more direct method like direct visualization. We
were not able to observe and record the intraoperative status of the pulp
by direct visualization because after the patients had been triaged during
the emergency visit, they were referred for various treatment modalities.
However, we know that cold testing has been shown to have high
sensitivity and specificity to differentiate pulpal vitality.
LIMITATIONS OF THE STUDY
17. CONCLUSIONS
• Percussion hypersensitivity on the healthy adjacent tooth is a frequent
observation in teeth with different pulpal diagnoses, and it strongly
predicted the overall severity of pain experienced. This suggested that
percussion hypersensitivity may identify a lowered pain threshold and
heightened pain sensitization and at times is primarily due to central
sensitization.
• Also, 2 different mechanical sensory tests (percussion hypersensitivity
and palpation hypersensitivity) differentially predicted the severity of
acute dental pain. Furthermore, they were identified with different
frequencies in patients with different pulpal diagnosis, suggesting that
these tests may be revealing different aspects of endodontic
pathophysiology and dental nociception. Importantly, pain as a highly
individualized, multifaceted phenomena may generally be a problematic
measure for inferring an endodontic diagnosis.
18. REFERENCES
• Sensory testing associates with pain quality descriptors during acute dental pain
Erdogan O, Malek M, Janal MN, Gibbs JL. Eur J Pain. 2019 Oct;23(9):1701-1711.
• Background: Pain descriptors capture the multidimensional nature of pain and
can elucidate underlying pathophysiological mechanisms. This study determined
whether the pain descriptors chosen by subjects experiencing acute dental pain
associate with the outcomes of two commonly performed dental sensory tests.
The goal of the study is to clarify whether pain descriptors are useful in
discriminating the underlying biological processes contributing to dental pain.
• Methods: Participants (n = 228) presenting with acute toothache underwent
standardized clinical dental sensory testing and described their pain in reference
to 22 pain quality descriptors. Univariate and two-way ANOVA determined the
relationship between groups defined by cold detection (positive or negative) and
percussion hypersensitivity (painful or not) on the affected tooth, and pain
descriptor reporting.
19. • Results: Subjects experiencing painful toothache most frequently reported evoked
pain to temperature and chewing, and pain descriptors such as "throbbing" and
"aching." They also reported neuropathic pain descriptors such as "tingling" and
"electric shock." Subjects who detected a cold stimulus (thermal) on the affected
tooth, frequently reported high intensity paroxysmal shooting pain compared to
those that did not detect cold. By contrast, patients with percussion (mechanical)
hypersensitivity on the affected tooth, reported higher levels of global pain intensity
at rest and in function, and reported significantly higher intensity "radiating" and
"throbbing" pain, than subjects with non-painful percussion.
• Conclusions: The reporting of neuropathic pain descriptors by subjects experiencing
acute toothache was more frequent than expected, suggesting that neuropathic
mechanisms could contribute to typical toothache pain. Subjects experiencing
toothache with mechanical hypersensitivity experience more intense pain overall.
• Significance: In subjects experiencing acute toothache, specific pain descriptors
associate with the responses to routine clinical sensory tests performed on the
injured tooth. The frequent reporting of neuropathic pain descriptors suggests that
neuropathic mechanisms could create a diagnostic challenge to differentiate
toothache from intraoral neuropathic conditions. Persons experiencing toothache
with mechanical hypersensitivity experience more intense pain overall, suggesting
patients with this clinical feature will have distinct clinical pain management needs.
20. Preoperative pain and medications used in emergency patients with
irreversible acute pulpitis or acute apical periodontitis: a prospective
comparative study Touré B, Kane AW, Diouf A, Faye B, Boucher Y. J Orofac Pain. 2007 Fall;21(4):303-8.
• Aims: To determine the pain characteristics of and medications used for
patients seeking emergency care for irreversible acute pulpitis (IAP) or
acute apical periodontitis (AAP).
• Methods: General (age, sex, weight, general health) and specific (pain
intensity, localization, tooth mobility, lymphadenopathy, use of
medications) information was noted in 209 patients who appeared for
emergency care in 2 dental centers of Dakar with either IAP or AAP.
Statistical analysis was performed with the Mann-Whitney and chi-square
tests.
21. • Results: The sample comprised 97 IAP patients (46.4%) and 112 AAP patients
(53.6%); there were no significant differences between the 2 groups with
respect to age, sex, or weight. Of the involved teeth, 62% were mandibular and
38% were maxillary. IAP patients waited 6.6 +/- 5.3 days before seeking an
emergency consultation versus 5.0 +/- 3.8 days for AAP patients (P < .05). Severe
pain was reported in 75% of the IAP and 76% of AAP patients (not significant).
Percussion and apical palpation were painful only in AAP, in 98% and 40% of
patients, respectively. Mobility and adenopathies were noted only in AAP, in 87%
and 46% of patients, respectively (P < .001). Seventy-five percent of IAP patients
and 80% of AAP patients used medications, mainly non-narcotic analgesics,
which offered relief in 62% of IAP patients and 46% of AAP patients.
• Conclusions: Patients with IAP waited longer than those with AAP before
seeking treatment. Self-medication offered better relief in cases of IAP than in
cases of AAP. Pain to percussion and palpation, lymphadenopathies, and dental
mobility were strong indicators for AAP.