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PubMedDate not supplied

A clinical evaluation of the electric pulp tester as an indicator of local anesthesia.

Local anesthesia is the primary method in dentistry to control patients' pain. However, several studies have shown that profound anesthesia is not always achieved. The electric pulp tester has been used to measure the level of local dental anesthesia during endodontic therapy. However, no study has been performed that evaluates the ability of the electric pulp tester to predict the efficacy of local anesthesia prior to as operative procedure. If ineffective anesthesia could be predicted, supplemental injections could be administered to alleviate the anesthetic problem. The purpose of this study was to evaluate the ability of the electric pulp tester to measure the level of local anesthesia prior to operative treatment. The study was performed in vivo on patients requiring operative therapy. All teeth were pulp tested preoperatively for vitality using the electric pulp tester. After injection of local anesthetic, traditional parameters of dental anesthesia were verified (lip numbness, mucosal sticks). Teeth were then retested with the electric pulp tester and the results recorded. The teeth were them prepared for restoration using conventional instrumentation, and the patient's level of anesthesia evaluated using a visual analog scale. The electric pulp tester readings were compared to the patient's responses using Fisher's Exact test (two-tail). The results indicate that the electric pulp tester can be a valuable tool in predicting potential anesthetic problems in operative (restorative) dentistry.

Adolescent↗
PubMed1983

An unusual instance of leukemic infiltrate. Diagnosis and management of periapical tooth involvement.

The clinical course of an adult patient with relapsed acute myelogenous leukemia and leukemic infiltrate periapical to the dentition is described. While the oral symptoms were indicative of pulpal disease requiring dental therapy to resolve the patient's complaint, roentgenographic, dental pulp testing, and histologic analysis revealed extramedullary infiltrate apical to a mandibular molar. The findings developed coincident with relapse of leukemia; the medical and dental testing described above were essential in establishing an accurate diagnosis. While most oral leukemic infiltrates affect the gingiva, in this patient the infiltrate involved periapical tissue which was not clinically observable.

Adult↗
PubMed2005

An investigation of language used by children to describe discomfort expected and experienced during dental treatment.

OBJECTIVES: A study of dental pulp testing has shown that children's linguistic comprehension and chronological age independently influence their descriptions of pain. The present study sought first to demonstrate this for expectations and experience of routine dental treatment, and secondly, to determine whether the effect of age was the result of previous dental and medical experience. SAMPLE: Forty-six children between 6 and 17 years of age attending two paediatric dental clinics for routine invasive procedures comprised the study sample. METHODS: To describe their expectations of forthcoming treatment, each child selected words from a published list, and gave ratings on scales describing the degree of severity as 'sore' or 'tingly'. They also completed the Child Dental Anxiety Scale and the Spielberger State-Trait Anxiety Scale for Children. After treatment, they described the treatment with the same list and scales, then completed the British Picture Vocabulary Scale and a dental-medical history questionnaire. RESULTS: The children, especially the most anxious ones, chose more words from the list for their expectations than for their experience of treatment, suggesting, as in previous studies, that they expected more discomfort than they experienced. Ratings of 'sore' and 'tingly' did not show this discrepancy. For both expectations and experience of treatment, the children with the largest vocabularies chose the fewest words, thus being more discriminating in their choices. However, vocabulary had no effect on ratings of 'sore' and 'tingly'. There were no significant relationships among age, estimates of discomfort and medical-dental histories. CONCLUSIONS: The results suggest that a list of adjectives provides the most discriminating measure of discomfort. They also show that it is necessary to take into account children's linguistic development to evaluate their estimates of pain so as not to entertain the belief of many clinicians that children exaggerate such reports.

Adolescent↗
PubMed1980

The importance of methodology in the evaluation of pulp reactions.

Studies of pulp reactions to restorative materials are the final arbiter of the acceptability of the material for clinical use. The techniques commonly employed suffer from the occurrence of artefacts which may lead to incorrect conclusions being drawn. Many of these errors can be avoided by strict adherence to methodology in the choice and processing of specimens and in the interpretation of histological findings. Attention is drawn to the lack of correlation between clinical symptoms and histological appearances. The effects of specimen preparation, including fixation and demineralization are discussed in relation to both the pulp and its surrounding dentine. The advantages and disadvantages of using young teeth in preference to those from older individuals and of carious as against intact teeth are set out. The application of results in tests on animal teeth to the human situation is shown to be unreliable because of differences in composition and reaction time. Methods of inducing inflammatory changes in normal pulps are described and the possibility of using other criteria for the investigation of pulp reactions is explored.

Animals↗
PubMed1991

Clinical evaluation of pulp and dentine sensitivity after supragingival and subgingival scaling.

The exposure of dentinal tubules by the removal of root cementum on scaling procedures has been proposed to be a source of pulp injury and to cause dentine hypersensitivity. The aim of this study was to evaluate the sensitivity of the pulp and dentine after supragingival and subgingival scaling. Eleven patients with periodontally diseased mandibular incisors were selected. The subjects were divided into two groups according to marginal bone loss. The pulp sensitivity was evaluated by an electric pulp test. Dentine sensitivity was evaluated with two forms of controlled stimulations (probe and air-jet) and with a questionnaire. No changes in pulp sensitivity were found after scaling, but a clinically significant increase in dentine sensitivity to probe and/or air stimuli was observed in 6 patients. Five of these were also sensitive to daily life stimuli. A natural mechanism of desensitization seemed to have occurred two weeks after subgingival debridement. This study showed that supragingival and subgingival scaling might cause a more or less transient occurrence of dentine hypersensitivity.

Adult↗
PubMed1990

Pulpal and root sensitivity rated to periodontal therapy.

The purpose of this clinical investigation was to determine if periodontal treatment consisting of scaling, root planing, and periodontal surgery produced any change in pulpal or root sensitivity. Ten patients were tested, with a total of 84 observations. There were 42 periodontally treated teeth, with 42 contralateral teeth serving as control specimens. The teeth were evaluated with stimuli from an electric pulp tester, cold, and air. The electric pulp tester was found to be reliable in assessing the pulpal sensitivity. Neither the amount of periodontal destruction nor the extent of periodontal treatment had any effect on the pulp. Scaling and root planing had no significant effect on root sensitivity. Periodontal surgery was directly related to root sensitivity in terms of the extent of root surface exposure. An association was observed clinically between plaque accumulation after periodontal surgery and root sensitivity.

Adult↗
PubMedDate not supplied

Temporary and permanent restorations for fractured permanent teeth with immature apices: a clinical study.

Clinical and radiological studies of the fractured teeth of patients between seven and eleven years old were conducted to assess the use of permanent and immediate (emergency) techniques for reconstructing anterior permanent teeth with immature apices. The general hypothesis states that, given the physical and biocompatible properties of the materials used in the immediate (emergency) technique, there are no significant differences between the two techniques as far as pulp vitality and apical growth are concerned. A sample of fifty-six patients was selected. They had Class I, II or III fractures, for which permanent and immediate (emergency) techniques were used in equal numbers. Thermal, mechanical, and electrical tests were used to evaluate pulp vitality compared with the homologous tooth. Apical convergence was the radiological criterion used for determining the end of the radicular process. After one year, both techniques allow preservation of pulp vitality. Results show that, unlike the conventional technique (permanent), radicular formation was completed first in teeth reconstructed using the immediate (emergency) technique. Statistical analysis shows no definitive relationship between the technique used and completion of apical growth time (P > 0.05). In conclusion, comparison between the mediate (permanent) and immediate (emergency) techniques shows that the immediate (emergency) technique is an adequate alternative for reconstructing fractured teeth, because of the greater esthetic and functional advantages at the patient's disposal.

Biocompatible Materials↗
PubMed2002

The effect of electrical dental equipment on a vagus nerve stimulator's function.

BACKGROUND: Dental patients who have epilepsy with pharmacologically refractory seizures may be treated with an implanted pulse generator that electrically stimulates the left vagus nerve. The pulse generator functions like a cardiac pacemaker. Some electrical dental devices have been shown to cause electromagnetic interference with the function of cardiac pacemakers. The potential effect of similar dental equipment on vagus nerve stimulators is unknown. METHODS: Common electrical dental devices were operated at maximum power settings in close proximity to a representative vagus nerve stimulator. The author assessed any interference of the dental devices with the nerve stimulator function by observing oscilloscope tracings. RESULTS: Under the conditions of this evaluation, none of the dental devices tested altered the function of the vagus nerve stimulator. CONCLUSIONS: Some commonly used electrical dental devices may be used in close proximity to patients who have implanted vagus nerve stimulators without adverse effects on the nerve stimulator function. CLINICAL IMPLICATIONS: Dentists and dental hygienists may encounter patients with implanted vagus nerve stimulators, and they need to be cognizant of developments in the treatment of epilepsy. Under the conditions of this study, use of common dental electrical devices did not alter the function of a vagus nerve stimulator. The findings of this study, however, should not be generalized to all types of electrical dental or medical devices, as a recent report indicates that treatment with diathermy devices is contraindicated for patients with implanted nerve stimulators.

Dental Amalgam↗
PubMed1976

Influence of splints and temporary crowns upon electric and thermal pulp-testing procedures.

The influence of different splints and temporary crowns upon the reliability of electric and thermal pulp-testing procedures was examined in 10 patients with vital maxillary central incisors and 10 patients with vital maxillary central incisors and 10 patients with unilateral pulp necrosis of a central incisor. The pulp-testing procedures were: (1) Bofors Pulp Tester, (2) Siemens Sirotest, (3) heated guttapercha, (4) ice, and (5) carbon dioxide snow (Odontotest). The splints or temporary crowns were: (1) silver cap splint, (2) acrylic cap splint, (3) Hawley orthodontic plate, (4) Saur's arch bar, (5) orthodontic bands, (6) stainless steel crown, and (7) stainless steel crown with labial surface removed. A reliable electrometric pulp response could only be elicited if the pulp tester was applied directly upon enamel and preferably upon the incisal edge. In this instance metal splints or partial steel crowns applied to the tooth had no effect on the pain threshold. A false positive reaction in case of pulp necrosis was only elicited when the electrode was placed directly upon metal which contacted neighboring vital teeth. The use of ice and heated guttapercha appeared to be of limited value, due to inconsistent pulp responses. Carbon dioxide snow gave a reliable response, unless applied on the incisal edge.

Adult↗
PubMed2000

Efficacy of bonded and nonbonded amalgam in the treatment of teeth with incomplete fractures.

BACKGROUND: This clinical study compared the efficacy of adhesive-retained vs. pin-retained complex amalgam restorations in the treatment of molars with incomplete fractures. Both relief of chewing pain and cold sensitivity were evaluated at two weeks, three months and one year. METHODS: The authors treated 38 patients with a chief complaint of chewing sensitivity on vital molar teeth (40 teeth in the study). A random-number generator determined the treatment method for each tooth. Twenty teeth received bonded amalgam restorations. Twenty teeth received amalgapins or threaded pins to retain the amalgam. Teeth were evaluated for postoperative chewing sensitivity. A visual analog pain scale was used to evaluate cold response to a skin-refrigerant-soaked cotton pellet at each visit. After 12 months, all 40 teeth were available for evaluation. RESULTS: Chewing pain was completely eliminated in all but one tooth. A Student's t-test found no significant difference (P > .05) in preoperative cold sensitivity between the bonded and nonbonded groups. A paired t-test comparison indicated that the teeth in the bonded group were significantly less sensitive to cold after three months and 12 months than they were at the time of the baseline measurements (P < .0001). A paired t-test indicated no significant difference between preoperative and postoperative cold sensitivity scores for teeth in the nonbonded group (P > .05). CONCLUSIONS: Both adhesively bonded and mechanically retained complex amalgam restorations were successful in resolving chewing sensitivity in cracked molars. For 39 of 40 teeth, chewing sensitivity did not return during the one-year follow-up period. At three months and 12 months, cold sensitivity was reduced in the bonded restorations. At all three time periods, cold sensitivity remained similar to baseline levels for the mechanically retained restorations. CLINICAL IMPLICATIONS: Incomplete tooth fracture in molars can be successfully treated by covering fractured cusps with amalgam restorations. This study excluded teeth with prolonged sensitivity to a cold stimulus or those with periodontal evidence of root fracture. With these exclusions, elimination of chewing sensitivity was predictable. Teeth restored with bonded restorations experienced a decrease in sensitivity to a cold stimulus at three months and at 12 months, but not at two weeks. The cold sensitivity of teeth restored with nonbonded restorations was similar at baseline, two weeks, three months and one year.

Adult↗
PubMed2005

Automatic stimulus breaker for electric dental pulp tester using pain response.

The pulp test provides a means of examining the vitality of dental pulp using physical or chemical stimulation. During electrical pulp testing, an electrical current stimulates the intradental nerve, which may be painful and stressful to patients. The study involved measurement of the electromyogram (EMG) from the anterior belly of the digastric muscle, finger movement and voice response during electrical pulp testing. The excessive stimulus time from the onset time of response (EMG, voice and finger movement) to the end of the stimulation was obtained. The results indicated that the responses occurred in the order: EMG, finger and voice. Based on these results, an automatic stimulus shut-off circuit was developed using the above-mentioned responses to stimulus during electric pulp testing. Excessive stimulus time was reduced by prompt switching-off of the pulp tester output, 64 ms on average after the first detected response (EMG). Consequently, excessive stimulus times were reduced by 284 and 152 ms on average for the subject and examiner disconnection, respectively, using the developed automatic shut-off circuit. Therefore it was possible to minimise pain and stress by reducing excessive pulp stimulation.

Adult↗