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PubMed1984

The predictive value of endodontic diagnostic tests.

The diagnostic usefulness of common endodontic tests was evaluated through the retrospective analysis of studies in which histologic examinations were performed. In general, tests were able to adequately identify persons who were likely to be free of disease but were substantially less effective in identifying disease-positive persons. Thus, persons who are test-positive for irreversible pulpal disease are frequently disease-negative on the basis of histologic examination. These findings suggest that practitioners continue to use all available evidence in making a diagnosis of irreversible pulpal disease.

Cold Temperature↗

PubMed1993

Pulpal anesthesia from an application of a eutectic topical anesthetic.

A new topical anesthetic agent, EMLA cream 5%, was investigated to determine if long application times could produce a degree of pulpal anesthesia. Thirteen subjects underwent testing in a double-blind manner. Pulpal anesthesia was assessed by electrical pulp testing. After the cream was applied for 15 to 30 minutes, 92% (12/13) of subjects reported no pain to the maximum setting of the pulp tester (300 V). The results of this study suggest EMLA cream has potential application in restorative dentistry and deserves further investigation.

Administration, Topical↗

PubMed1989

Pulp sensibility and pulp necrosis after Le Fort I osteotomy.

A longitudinal study comprising 617 teeth in 51 patients was carried out to determine the frequency of pulp necrosis and loss of pulpal sensibility after Le Fort I osteotomy. A negative pulpal sensibility was found in 39 (6%) teeth after an average follow-up period of 28 months, range 11-59 months. Development of pulp necrosis, determined by pulp testing and periapical radiolucency, was only demonstrated in 3 (0.5%) teeth. The extent of horizontal or vertical displacement of the maxilla had no influence on pulpal sensibility. Teeth adjacent to a vertical interdental osteotomy showed a significantly higher frequency of negative reactions compared to the group without an interdental osteotomy (p = 0.002). The canines demonstrated a significantly greater number of teeth with a negative sensibility reaction compared to the other tooth types. A close relationship between the apex of the canines and a wire osteosynthesis was demonstrated to have significant importance for pulpal sensibility.

Adolescent↗

PubMed1998

Anesthetic efficacy of the supplemental intraosseous injection of 2% lidocaine with 1:100,000 epinephrine in irreversible pulpitis.

The purpose of this study was to determine the anesthetic efficacy of a supplemental intraosseous injection of 2% lidocaine with 1:100,000 epinephrine in teeth diagnosed with irreversible pulpitis. Fifty-one patients with symptomatic, vital maxillary, and mandibular posterior teeth diagnosed with irreversible pulpitis received conventional infiltrations or inferior alveolar nerve blocks. Pulp testing was used to determine pulpal anesthesia after "clinically successful" injections. Patients who were positive to the pulp tests, or were negative to the pulp tests but felt pain during endodontic access, received an intraosseous injection using 1.8 ml of 2% lidocaine with 1:100,000 epinephrine. The results demonstrated that 42% of the patients who tested negative to the pulp tests reported pain during treatment and required supplemental anesthesia. Eighty-one percent of the mandibular teeth and 12% of maxillary teeth required an intraosseous injection due to failure to gain pulpal anesthesia. Overall, the Stabident intraosseous injection was found to be 88% successful in gaining total pulpal anesthesia for endodontic therapy. We concluded that, for posterior teeth diagnosed with irreversible pulpitis, the supplemental intraosseous injection of 2% lidocaine (1:100,000 epinephrine) was successful when conventional techniques failed.

Adult↗

PubMed2004

Use of laser Doppler flowmetry to predict vitality of luxated or avulsed permanent teeth.

OBJECTIVE: Splinting of traumatically displaced or avulsed permanent teeth has been described as an effective modality in the treatment of patients with dental injuries. The purpose of this study was to investigate whether laser Doppler flowmetry (LDF) measurements of pulpal blood flow (PBF) and/or dental injury type may predict treatment outcome of splinting of permanent maxillary incisors. STUDY DESIGN: The study comprised 64 patients undergoing dental trauma splinting, who were characterized by the presence of a single permanent maxillary incisor affected by a subluxation, luxation, or avulsion type injury. Perfusion units (PU) were taken in 2 sessions, on the day of splint removal (6 weeks after trauma; session I) and 12 weeks after splint removal (session II). At each session, when an injured permanent maxillary central incisor was recorded, the respective contralateral homologous tooth was used as a control. An adverse outcome occurring 36 weeks after splint removal was defined as the presence of "periapical radiolucency and/or grey discoloration." A multiple logistic regression analysis was used to compute the odds ratio for session-related PBF characteristics and dental injury type for adverse outcome (n=22) versus nonadverse outcome (n=42). RESULTS: There was a significant increase in PBF values from session I to session II (P=.047) for teeth without an adverse outcome, whereas teeth affected by an adverse outcome showed a significant decrease in PBF values (P=.001). PBF measurements did not change over time for the control group of contralateral incisors (P=.185). For the outcome criterion of "presence of periapical radiolucency and/or grey discoloration," there was a significant association between the treatment outcome groups and the variables of dental injury type (P=.049), session-related PBF difference (P=.000), and session II-related PBF level (P=.000). Significant increase in risk of an adverse outcome occurred with a session-related PBF difference (PBF(Session I) - PBF(Session II)) of >/=0 PU (8.6 odds ratio) (P=.014), and a session II-related PBF level of </=2.8 PU (20.2 odds ratio) (P=.030). CONCLUSION: The data suggest the LDF test to be a valuable diagnostic adjunct for luxated teeth showing signs of adverse outcomes. Predictive modeling may provide clinicians with the opportunity to identify "at-risk" teeth early and initiate specific treatments.

Adolescent↗

PubMed1997

Susceptibility to pain in hypertensive and normotensive patients with coronary artery disease: response to dental pulp stimulation.

An association between a decreased responsiveness to varying painful stimuli and arterial hypertension both in animals and in humans has been documented. The relationship between essential hypertension and silent myocardial ischemia in coronary artery disease (CAD) populations is not well understood. The aims of this study in CAD patients with and without essential hypertension were (1) to determine dental pain threshold and reaction to tooth pulp stimulation and (2) to ascertain whether hypertensive CAD patients differ from normotensive ones in reactivity to pain. This study involved 182 patients who were affected by mild and moderate hypertension (G1) and 174 normotensive patients (G2). The inclusion criteria were reproducible exercise-induced myocardial ischemia, CAD documented at angiography, and dental formula suitable for pulp test. All patients underwent an ergometric stress test, coronary angiography, and pulp test. Our CAD hypertensive patients showed a lower prevalence of angina during daily life (64.8% in G1 versus 81.6% in G2, P<.05) and a higher incidence of exercise-induced silent myocardial ischemia (60.4% in G1 versus 48.8% in G2, P<.05) than the normotensive group. The mean anginal pain intensity, which was suffered both during spontaneous transitory episodes of ischemia and/or during acute myocardial infarction, was significantly lower in G1 than in G2 patients (P<.05). During pulp test, 31.8% of G1 and 13.7% of G2 referred no symptoms, even at the highest current intensity of 500 mA. The hypertensive patients with symptoms during pulp test had a higher mean dental pain threshold and lower mean threshold reaction and maximal reaction than did the normotensive symptomatic ones. In patients of both groups, a positive correlation between the mean maximal reaction during pulp test and the prevalence of angina during daily life was also found. In conclusion, patients with CAD and essential hypertension differ from normotensive CAD patients in reactivity to pain. Significantly higher pain thresholds and lower reactions to tooth pulp stimulation characterized patients with increased blood pressure values.

Blood Pressure↗

PubMed1998

The effect of occlusal reduction on pain after endodontic instrumentation.

One hundred seventeen patients with posterior teeth requiring endodontic treatment were studied. Specific clinical findings were recorded, including pulp, vitality, preoperative pain, sensitivity to percussion, and the presence of a periradicular radiolucency. Excluded from the study were teeth with restorations to be maintained, greater than class I mobility, pocket depths > 5 mm, endodontic retreatments, and patients taking pain altering medications. Teeth were randomly assigned to 1 of 3 groups: (i) total occlusal reduction, (ii) simulated occlusal reduction (nonfunctional cusp reduction), or (iii) control (occlusion untouched). After canal instrumentation, a questionnaire was used by patients to record pain responses over a 48-h post-operative period. Responses were tabulated using a chi(2) test (p = < 0.05), and a statistically valid profile of patients most likely to benefit from occlusal reduction was developed. Occlusal reduction should prevent postoperative pain in those patients whose teeth initially exhibit pulp vitality, percussion sensitivity, preoperative pain, and/or the absence of a periradicular radiolucency.

Chi-Square Distribution↗

PubMedDate not supplied

Evaluation of a laser Doppler flowmeter to assess blood flow in human primary incisor teeth.

PURPOSE: This study determined whether the portable Advance Laser Flowmeter Model 21, a clinical instrument, would indicate significant values when pulpal blood flow was present or absent; whether the analog output of the flowmeter was time-linked to the heart rate; and whether labial and lingual crown surfaces produced different flow values. METHODS: Teeth were tested under two conditions: with the teeth in situ and extracted, or with the pulp present and removed. RESULTS: Values before and after the teeth were extracted, and those before and after pulpectomy with the tooth in situ were significantly different. These findings verified that the flowmeter measured the presence of bloodflow. Peaks of the electrocardiogram waves and the regular signal fluctuations of the flowmeter were time-linked and verified the measurement of the heart rate from the dental pulp. Differences in the values for the lingual and labial surfaces of individual teeth were not significant. CONCLUSIONS: This instrument proved a valid means of determining the presence of pulpal blood flow in primary incisors.

Child↗

PubMed2002

A comparison of ropivacaine and lidocaine with epinephrine for intraligamentary anesthesia.

OBJECTIVE: The purpose of this study was to compare the efficacy of 2 different concentrations of ropivacaine with lidocaine containing epinephrine for intraligamentary anesthesia. STUDY DESIGN: Ethical approval was obtained and a randomized, double-blind, cross-over volunteer investigation was conducted. Twenty-four volunteers had intraligamentary injections of 2% lidocaine with 1:80,000 epinephrine, 0.75% ropivacaine, or 1% ropivacaine at the upper lateral incisor and lower first bicuspid teeth. The response of the test teeth to electrical pulp testing and the reaction of the gingiva to sharp probing were assessed up to 29 minutes after injection. Injection discomfort and side effects were also recorded. Data were analyzed by using the chi-square test and analysis of variance. RESULTS: Lidocaine with epinephrine was more successful than the ropivacaine solutions in obtaining pulpal anesthesia (chi-square = 12; P <.002) and produced longer-lasting pulpal (F = 21; P <.001) and soft tissue (F = 16; P <.001) anesthesia. Injection discomfort and incidence of side effects were similar between solutions, and none produced serious adverse effects. CONCLUSION: Lidocaine with epinephrine is more effective than ropivacaine as an intraligamentary anesthetic.

Adult↗

PubMed1975

The indications for the transplantation of maxillary canines in the light of 100 cases.

One hundred cases of autogenous transplantation of maxillary canines are reviewed and the results assessed. They were divided into Group A, 50 cases 3 to 10 years out of retention, and Froup B, 50 consecutive cases 1 to 3 years out of retention. If the criteria for success depended on a normal response to vitality test, 62 per cent of Group A and 24 per cent of Group B were successful. If a prognosis rating was used, 68 per cent of Group A and 72 per cent of Group B had a good prognosis.

Alveolar Process↗

PubMed2004

Articaine and lignocaine efficiency in infiltration anaesthesia: a pilot study.

AIM: The purpose of this study was to evaluate the onset of action of pulpal and soft tissue anaesthesia, and pain experience after buccal and palatal infiltrative injections with 4% articaine with 1:100,000 adrenaline, and 2% lignocaine with 1:100,000 adrenaline. METHOD: A double blind cross-over study was conducted with 20 healthy adult subjects who, in two appointments at least two weeks apart, randomly received an infiltration anaesthesia with the solutions in the buccal and palatal regions of the upper right canine. The tooth was tested with a pulp tester before (to establish its baseline response), and after the injection, until return to the base threshold level. The pain experience caused by palatal injection was verified by the visual analogue scale (VAS). Data were analysed using Wilcoxons test (alpha = 0.05). RESULTS: There were no significant statistical differences between the solutions with respect to VAS (p = 0.45), onset of action (p = 0.80) and pulpal (p = 0.08) and soft tissue (p = 0.18) anaesthesia duration, although pulpal anaesthesia may have reached statistical significance if a higher number of volunteers had been used. CONCLUSION: Under the conditions of this study it can be concluded that both anaesthetic solutions showed similar pain experience.

Adult↗

PubMed1989

A comparison of pulpal and tactile detection threshold levels in young adults.

Pulpal and tactile sensory detection threshold (SDT) values of the maxillary and mandibular incisor and canine teeth were determined and recorded for young adult subjects at three test sessions. A commercially available monopolar pulp-testing device was used to determine pulpal SDT values, and von Frey hairs were used to determine the tactile SDT values. Statistical analysis of the data indicated that the pulpal and tactile test procedures were sufficiently reliable in identifying what is defined as the true SDT value for both parameters. The study confirmed the constancy of these SDT values over days and the independence of the values for jaw, side, and sex. SDT values were influenced, however, by tooth type, with canine teeth displaying higher tactile and pulpal values than the central and lateral incisor teeth. These data should provide a suitable baseline for a longitudinal study to identify the SDT fluctuations known to occur in tooth pulp and dental supporting tissues in a growing human population.

Adult↗

PubMed1996

Evaluation of a pulse oximeter and customized probe for pulp vitality testing.

Current routine methods for assessment of pulp vitality rely on stimulation of A-delta nerve fibers and give no direct indication of blood flow within the pulp. Recent papers have suggested that pulse oximeters may be used to diagnose pulp vitality by detection of blood flow. In this study, an optimized pulse oximeter probe for teeth was designed, built and tested using the Biox 3740 Oximeter (Ohmeda, Louisville, CO). Following preliminary in vitro tests, the probe was tested clinically. Pulse waveforms from maxillary and mandibular anterior teeth were noted. Simultaneous readings from the subjects' finger were used as controls. Pulse wave readings from the teeth were found to be synchronous with the finger probe, but not consistently. It was easier to maintain continuous readings from mandibular incisors than from maxillary incisors. The average percentage synchronization with the pulse was 28.95% for maxillary incisors and 50.28% for mandibular incisors. This difference was significant (p = 0.05). The overall accuracy of the commercial instrument was disappointing, and in its present form it was not considered to have clinical value.

Artifacts↗

PubMed2006

Speed of injection influences efficacy of inferior alveolar nerve blocks: a double-blind randomized controlled trial in volunteers.

This randomized double-blind crossover trial investigated the efficacy and discomfort associated with slow (60 seconds) and rapid (15 seconds) inferior alveolar nerve blocks (IANB) using 2.0 ml of 2% lidocaine with 1:80,000 epinephrine in securing mandibular first molar, premolar and lateral incisor pulp anesthesia in 38 healthy adult volunteers. Episodes of maximal stimulation (80 microA) without sensation on electronic pulp testing were recorded. Injection discomfort was self-recorded by volunteers on 100 mm visual analogue scales. Data were analyzed by McNemar, Friedman, Wilcoxon Signed Ranks, and paired t tests. Slow IANB produced more episodes of no response to maximal pulp stimulation than rapid IANB in molars (220 episodes versus 159, p < 0.001), premolars (253 episodes versus 216, p = 0.003) and lateral incisors (119 episodes versus 99, p = 0.049). Slow IANB was more comfortable than rapid IANB (p = 0.021).

Adult↗

PubMed2005

[Laser Doppler flowmetry for vitality testing of traumatized maxillary incisors].

Pulp sensitivity and vitality changes were evaluated in 69 traumatized maxillary incisors and in 38 control teeth during a follow-up period of 20 months. Examinations included thermal testing using carbon dioxide snow (CO2) and the laser Doppler flowmetry (LDF). These measurements were compared to the clinical and radiological findings. In 47.8% of the traumatized teeth and in 55.3% of the control group the three LDF measurements corresponded with the sensitivity testing using CO2 and with the clinical and radiological findings. In 31.9% of the traumatized teeth and in 7.9% of the control group the LDF-measurements differed from the CO2-measurements, but were in agreement with the other clinical and radiographic findings. The information obtained by laser Doppler flowmetry is of additional importance for the treatment planning. Since the clinical examination of traumatized teeth is sometimes inconclusive, the laser Doppler flowmetry is a further diagnostic tool but it cannot replace the radiological or clinical examination.

Adolescent↗

PubMed1991

Reliability of pulpal blood-flow measurements utilizing laser Doppler flowmetry.

Pulpal blood flow can now be measured non-invasively in the clinic utilizing laser Doppler flowmetry. The purpose of our study was to test (1) whether the position of the measurement probe on the tooth affects blood-flow measurements and (2) whether measurements from identical locations vary over time. Blood flow of one maxillary central incisor was measured in each of 13 volunteers. Measurements were recorded at five different locations on the labial surface of each tooth. Four measurement sessions were performed, and two sets of measurements were recorded at each session. Custom-made splints ensured accurate and reproducible positioning of the measurement probe at each session. Spatial position of the probe had a clear effect on the pulpal blood-flow measurements (p less than 0.0001). Measurements made at incisal and gingival locations were less and greater (p less than 0.05), respectively, than those made at central locations. Measurements from various mesio-distal locations did not differ (p greater than 0.05) when made at the same height on the tooth. Pulpal blood-flow measurements recorded at a given site were not consistent across all of the testing sessions (p less than 0.0001). Our data suggest that reliable interpretation of longitudinal measurements of pulpal blood flow obtained with laser Doppler flowmetry requires accurate repositioning of the measurement probe. In addition, an adequate control condition should be included to account for bias due to temporal variation.

Adult↗

PubMedDate not supplied

Use of verbal descriptors, thermal scores and electrical pulp testing as predictors of tooth pain before and after application of benzocaine gels into cavities of teeth with pulpitis.

A double-blind pilot study was conducted on 27 consenting human volunteers who had irreversible pulpitis associated with persistent toothache pain from open carious lesions. Formulations tested contained either 0, 10%, or 20% benzocaine and were identified only by a numbered code. Before the experiment started, a small amount of a known 5% benzocaine gel was placed for 1 minute on the tongue of each patient to assure a sensation of numbness within the oral cavity. Then the test tooth was washed with a gentle stream of warm water and dried with gauze. A randomly selected test medication was placed into the open cavity and around the gingival margins for 5 minutes. Pre- and posttreatment tests were conducted at the following timed intervals: 0, 5, 15, 30, 45, 60, 75 and 90 minutes. The tests included degree of pain (rated: 0 = none, 1 = mild, 2 = moderate, 3 = severe); electrical pulp testing (EPT) by a modified, voltage-ramping instrument; and ice water testing (0.5 mL directed quickly onto sound enamel of the tooth and rated: 0 to 4, with 4 being intolerable). After testing, or when pain returned to baseline, endodontic procedures were performed. There was a significant increase (p < 0.032, Fisher exact test) in subjects obtaining pain relief, rated by verbal descriptors, from the benzocaine gels (14 out of 18 improved) compared to placebo (3 out of 9 improved). It was concluded that: 1) benzocaine gels are effective formulations for temporary relief of toothache pain, 2) there were no statistical differences in EPT scores between teeth having pulpitis and control teeth, 3) there were no correlations between direction of EPT scores and pain relief, 4) cold water testing was a good predictor of whether or not a tooth had pulpitis, and 5) changes in cold water testing scores after treatment could not be correlated to relief of pain according to verbal descriptors. The effectiveness of benzocaine in relieving toothache pain verifies previous studies; however, a difference between 10% and 20% benzocaine could not be demonstrated probably because of two factors: 1) the present experiment had a small sample size, and 2) there was no direct measurement of duration of local anesthesia.

Adult↗

PubMed1999

A comparison of laser Doppler flowmetry with other methods of assessing the vitality of traumatised anterior teeth.

Laser Doppler flowmetry is a non-invasive electrooptical technique which allows the semi-quantitative recording of pulpal blood flow. This study aimed to determine the reliability (measured as the sensitivity and specificity) of laser Doppler flowmetry as a method of assessing the vitality of traumatised anterior teeth, and to compare it with standard pulpal diagnostic tests. Recordings of pulpal blood flow were taken from 67 non-vital anterior teeth (55 patients), where the pulpal status was confirmed by pulpectomy. For comparison, recordings were also taken from 84 vital anterior teeth (84 patients). Analysis of the recordings allowed diagnostic criteria to be developed which gave the technique a sensitivity and specificity of 1.0 for this sample. None of the other standard pulpal diagnostic methods tested was as reliable. This was usually due to low sensitivities, which ranged between 0.92 for sensibility testing with ethyl chloride down to 0.36 for periapical radiolucency and 0.16 for a history of pain. Laser Doppler flowmetry was found to be a reliable method of assessing the pulpal status of traumatised anterior teeth, although it is technique-sensitive and time-consuming to use.

Adolescent↗