Toothaches that aren't really toothaches.
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Dental Pulp Diseases↗
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The dynamics of toothache pain and dental services utilization: 24-month incidence.
OBJECTIVES: The aims of this study were twofold: (1) to describe patterns of change in reported toothache pain, and (2) to examine the impact of toothache pain on dental care utilization and vice versa. METHODS: Data from the Florida Dental Care Study (FDCS), a longitudinal study of oral health and dental service utilization conducted in north Florida, were used to measure self-reported toothache pain among dentate adults at baseline and four subsequent times during a 24-month period. Only persons 45 years of age or older with at least one remaining natural tooth at baseline were eligible. A total of 873 subjects participated, 764 of whom participated through 24 months. The analysis is focused on modeling transitions in the reported experience of toothache pain during intervals of six months. RESULTS: At the time of the baseline interview, 11.5 percent of subjects reported current toothache pain. During subsequent six-monthly interviews, from 13.4 percent to 21.6 percent of subjects reported having experienced toothache pain during the prior six-month interval. Among those with no toothache pain at baseline (n = 772), 31.2 percent experienced toothache pain at some time during the 24-month study period. The six-month incidence probability reflects the likelihood of developing toothache pain by estimating the conditional probability of reporting a toothache in a later interval given that this problem was not reported in the earlier one (for consecutive pairs of intervals). Overall, the six-month incidence probability for toothache pain in this study was. 11. Significantly higher 24-month incidence was observed for African-American subjects, those with less formal education, those in poorer financial circumstances, and problem-oriented dental attenders. CONCLUSIONS: In this diverse sample of adults, toothache pain occurs frequently and is quite variable overtime. Toothache occurs in conjunction with various forms of self-reported oral disease (e.g., abscess, cavities) or tissue damage (e.g., loose tooth, broken tooth, bleeding gums). Subjects who experience toothache are slightly more likely than others to utilize dental services in the time period proximate to the toothache pain.
Aged↗
Non-odontogenic toothache.
Toothache is a common complaint in the dental office. Most toothaches have their origin in the pulpal tissues of periodontal structures. These odontogenic pains are managed well and predictably by dental therapies. Non-odontogenic toothaches are often difficult to identify and can challenge the diagnostic ability of the clinician. The most important step toward proper management of toothache is to be suspicious that the pain may not be of dental origin. The cardinal warning symptoms of non-odontogenic toothache are as follow: A. Spontaneous multiple toothaches. B. Inadequate local dental cause for the pain. C. Stimulating, burning, non-pulsatile toothaches. D. Constant, unremitting, non-variable toothaches. E. Persistent, recurrent toothaches. F. Local anesthetic blocking of the offending tooth does not eliminate the pain. G. Failure of the toothache to respond to reasonable dental therapy.
Dental Pulp Diseases↗
Nonodontogenic toothache.
Toothache is a common complaint in the dental office. Most toothaches have their origin in the pulpal tissues or periodontal structures. These odontogenic pains are managed well and predictably by dental therapies. Nonodontogenic toothaches are often difficult to identify and can challenge the diagnostic ability of the clinician. The most important step towards proper management of toothache is to be suspicious that the pain may not be of dental origin. The cardinal warning symptoms of nonodontogenic toothache are as follows (28): a. spontaneous multiple toothaches; b. inadequate local dental cause for the pain; c. stimulating, burning, nonpulsatile toothaches; d. constant, unremitting, nonvariable toothaches; e. persistent, recurrent toothaches; f. local anesthetic blocking of the offending tooth does not eliminate the pain; and g. failure of the toothache to respond to reasonable dental therapy.
Facial Pain↗
Nonodontogenic toothache.
Toothache is a common complaint in the dental office. Most toothaches have their origin in the pulpal tissues or periodontal structures. These odontogenic pains are managed well and predictably by dental therapies. Nonodontogenic toothaches are often difficult to identify and can challenge the diagnostic ability of the clinician. The most important step toward proper management of toothache is to consider that the pain may not be of dental origin. Signs and symptoms suggestive of nonodontogenic toothache are as follows: 1. Inadequate local dental cause for the pain. 2. Stimulating, burning, nonpulsatile toothaches. 3. Constant, unremitting, nonvariable toothaches. 4. Persistent, recurrent toothaches over months or years. 5. Spontaneous multiple toothaches. 6. Local anesthetic blocking of the suspected tooth does not eliminate the pain. 7. Failure to respond to reasonable dental therapy of the tooth.
Anesthetics, Local↗
Perceived inability to cope and care-seeking in patients with toothache: a qualitative study.
AIMS: To explore the subjective experience of a sample of patients attending a dental teaching hospital emergency clinic with toothache. MATERIALS AND METHODS: Subjects 21 female and 14 male dental patients, of different ages, marital status, employment status and levels of education, presenting with toothache at a dental teaching hospital emergency clinic. Data collection Unstructured in-depth interviews, following a topic guide. Analysis Transcribing, sifting, indexing and charting data according to key issues and themes. FINDINGS: A dimension of toothache pain that emerged was the perceived inability to cope. Patients reported a dependency on a dentist or other person to alleviate their pain, suggesting connotations of helplessness, disempowerment and incapacitation. The perceived inability to cope was also expressed in terms of loss of control, despair and isolation. A number of care-seeking patterns for toothache was identified: repeated visits to the same dentist for emergency care, repeated visits to different dentists, attendance at the dental hospital emergency clinic and consulting non-dental health workers such as doctors and pharmacists. CONCLUSIONS: The perceived inability to cope and care-seeking patterns are two unexplored dimensions of the toothache pain experience. Both dimensions may be associated with pain intensity, the clinical conditions that manifest as toothache, quality of treatment provided and management of demand for emergency dental care. A conceptual framework is proposed for future research to investigate these relationships.
Adolescent↗
The trend and risk factors of perceived toothache among Finnish adolescents from 1977 to 1997.
Toothache is a subjective oral health indicator that should become uncommon when oral health is improving. The aim of this study was to assess changes in perceived toothache between 1977 and 1997 among Finnish adolescents. In the Adolescent Health and Lifestyle Survey, a self-administered questionnaire was mailed to a representative sample of 12-, 14-, 16-, and 18-year-old Finns every second year. The sample sizes in the surveys varied from 2422 to 11,105, making a total of 35,349 subjects in the entire study. The incidence of toothache during the previous 2 years was requested in 1977, 1985, 1991, 1995, and 1997, and the prevalences were 31%, 25%, 28%, 29%, and 37%, respectively. The increase between 1995 and 1997 was highest among 16- and 18-year-olds. There was no tendency for perceived toothache to decline over the study period, despite the decrease in caries experience. Toothache varied by age, socioeconomic status (SES), place of residence, and toothbrushing frequency. The increase in the incidence of toothache reported after 1995 could be a warning signal that economic recession in Finland has caused changes in the dental care system.
Adolescent↗
Severeness of toothache and other symptoms as a function of frequency of occurrence and intensity.
The relative severeness of toothache and two non-dental symptoms (headache, stomach complaints) was judged by men and women (n = 47). Each symptom was specified for two frequencies of occurrence (from time to time and regular) and two levels of intensity (minor and heavy). The methods used were paired comparisons and direct ranking of the 12 (3 X 2 X 2) verbal stimuli. Subjects were highly consistent in their pairwise choices. Agreement between judges was also highly significant. The overall ordering of the severity of the stimuli showed a perfect correspondence between the two methods. 'Heavy regular headache', 'heavy regular stomach complaints', and 'heavy regular toothache' were the three symptoms judged most severe. Headache, stomach complaints and toothache, specified as low on frequency and intensity, were judged least severe. Log-linear model fitting showed that the influence of intensity on the preference of a symptom is independent of the frequency of occurrence, and vice versa.
Female↗
Analgesic onset time as a measure of topical anesthetic efficacy in spontaneous toothache pain: a pilot study.
The purpose of this pilot investigation was to determine the usefulness of analgesic onset time as a measure of topical anesthetic efficacy in patients with spontaneous toothache pain. Under blinded conditions, 20 patients with spontaneous toothache pain from an open tooth cavity were randomly assigned to receive either 20% benzocaine or placebo (80% polyethylene glycol). The medication was applied directly to the open cavity in a volume of 3 drops. Patients then depressed a stop watch when they initially experienced pain relief. Patients who did not obtain relief were assigned the maximum onset value of 600 seconds. The average analgesic onset time was 111.8 seconds in the benzocaine group and 289.0 seconds in the placebo group. In the benzocaine group, 90% of the patients reported some pain relief, while a surprisingly high 60% reported some pain relief in the placebo group. The results of this study suggest that in the spontaneous toothache pain model, analgesic onset time is a valuable measure of topical anesthetic efficacy. In addition, polyethylene glycol at a concentration of 80% may not be a totally inactive vehicle.
Adult↗
Efficacy of using benzocaine for temporary relief of toothache.
The purpose of this investigation was to determine the efficacy of benzocaine for temporary relief of toothache. The agent used is available at drug counters; it contains 7.5 percent benzocaine in propylene glycol and has the form of a gel. The study was double blind. The agent and a placebo were provided by the manufacturer in an equal number of randomly numbered but otherwise unlabeled tubes. Forty-nine patients (twenty-five males and twenty-four females) with throbbing toothache pain resulting from dental caries were included in the study. The mean age was 25.6 years for patients receiving the drug and 26.7 years for patients receiving the placebo. Of the twenty-four patients who received the active agent, twenty (83 percent) were relieved of pain. The average time for onset of relief was 3.7 minutes. In the placebo group, only four patients (16 percent) were relieved of pain. When the chi-square test is used, the difference is statistically significant at the 0.01 level. No adverse reaction to the agents used was observed.
Adolescent↗
Applicability of the McGill Pain Questionnaire to the differentiation of 'toothache' pain.
The McGill Pain Questionnaire (MPQ) was administered to 102 'toothache' patients to determine whether it was sufficiently sensitive to distinguish between dental patients whose pain was clinically diagnosed as originating from a reversibly inflamed tooth pulp (group I) and those whose pain was diagnosed as originating from an irreversibly inflamed or necrotic pulp (group II). Scores for Total Pain Rank Index (PRI(T)), Sensory Pain Rank Index (PRI(S)), Evaluative Pain Rank Index (PRI(E)), Miscellaneous Pain Rank Index (PRI(M)), and Number of Words Chosen (NWC) were significantly higher (p less than 0.05) for group II patients. The PRI differences between both groups were attributed mainly to the more frequent selection by group II patients of 8 of the 20 subclasses of words and/or of words with higher rank values within the 8 subclasses. A significantly greater degree of sleep disturbance, nausea, headache, drowsiness and/or dizziness was also found in group II patients. Discriminant analysis using the 20 subclasses and 4 supplementary questions related to sleep disturbance, changes in food intake or activity levels, and accompanying symptoms, indicated that the MPQ, when used alone, correctly predicted diagnosis and treatment outcome in 73% of patients. Therefore, our findings indicate that the MPQ can distinguish between the two types of toothache and suggest that, especially when used along with other standard diagnostic tests, it may be a useful clinical adjunct in the diagnosis of dental pain.
Adolescent↗
Toothache--the 'hell of all diseases'.
Last year was the bicentenary of the death of Robert Burns, who is Scotland's best known poet. January 25, Burns' birth date, is also a well-known celebration to the Scottish-the famous 'Burns Night'. Burns wrote many songs and poems, but his 'Address to the Toothache' is of particular interest to dentists. The poem provides a vivid account of one man's experience of toothache and gives an insight into how people regarded pain two hundred years ago.
England↗
Malignant lymphoma of the maxillary sinus manifesting as a persistent toothache.
Many teeth have been mistakenly extracted or endodontically treated because of an incorrect diagnosis of orofacial pain, including toothache. A case of persistent toothache originating from a malignant lymphoma of the left maxillary sinus is presented. Root canal therapy and extraction of the upper left quadrant teeth from the canine to the second molar did not resolve the chief complaint. The patient was referred to a neurologist and received a diagnosis of a malignant lymphoma, a rare lesion of the maxillary sinus. This case stresses the importance of considering malignant neoplasm of the maxillary sinus as a potential etiologic factor in the differential diagnosis of orofacial pain.
Aged↗
Cough headache presenting as a toothache: a case report.
Benign cough headache (BCH) presents as an intermittent, usually bilateral, severe bursting or explosive pain brought on by coughing. Some of the known conditions which can mimic the pain experienced in BCH are subarachnoid hemorrhage, increased intracranial pressure, intracranial tumors, and even toothache. Careful evaluation must be carried out in order to differentiate between these conditions. A case of BCH which presented as a toothache is reported. The evaluation for exertional headaches, and for headaches brought on by coughing, is discussed.
Cough↗
Efficacy and tolerability of an intraoral benzocaine patch in the relief of spontaneous toothache pain.
OBJECTIVE: In this randomized, double-blind, placebo-controlled clinical trial, the effectiveness and tolerability of a novel intraoral benzocaine patch was evaluated in 60 patients who presented to the Dental School's emergency clinic with spontaneous toothache pain of at least a moderate intensity. METHODOLOGY: Mucoadhesive patches, containing either 12 mg of benzocaine or a matching placebo, were applied approximately two millimeters apical to the mucogingival junction of the symptomatic tooth and remained in place for 60 minutes. Pain intensity (0-4 scale) and pain relief (0-4 scale) were recorded every five minutes through 30 minutes, and then every ten minutes through the 90-minute time point. The onset times of first perceptible and meaningful relief were recorded using two stopwatches. The occurrence of adverse events was also monitored. RESULTS: While the benzocaine patches were numerically superior to the placebo patches at all time points with respect to pain relief, PID (pain intensity difference) and their summed measures (TOTPAR and SPID scores), an analysis of covariance revealed no significant differences between treatments. Survival analysis indicated that the percentage of patients reporting meaningful pain relief by 30 minutes was significantly (p < 0.05) greater in the benzocaine group than in the placebo group (77% for benzocaine and 47% for placebo). The median onset times to first perceptible and meaningful relief were 5.4 and 18.1 minutes in the benzocaine group, and 7.8 and 30.4 minutes in the placebo group. Only two side effects (headache) were reported in the entire study. CONCLUSION: Although the results of the present study were promising, further research on this novel delivery system of benzocaine is warranted to firmly establish efficacy in patients with spontaneous toothache pain.
Administration, Oral↗
Headache problems that can present as toothache.
Toothache of nonodontogenic origin may be better differentiated with the use of differential diagnostic blockade. Table 9 reviews the expected outcome of somatic block at the site of pain and when the nerve division or the site of nociception is blocked. Although there is considerable overlap, this technique together with a careful history and detailed physical examination will prevent many unnecessary irreversible treatments. If no sign of periapical pathology can be determined (radiography is normal) and the dental examination is nonrevealing, at least a 4-month period should be allowed to elapse before considering any irreversible dental procedure. During this time pharmacologic trials may be attempted, bearing in mind the clinical presentation. Patients should be informed that it may take at least 4 months for the dental pathology to manifest and in the hope of preventing irreversible damage, careful observation accompanied by the pharmacologic trials will be carried out. The practicing clinician is encouraged to maintain a broad perspective of the differential diagnosis of toothache when the pathology is not obvious.
Diagnosis, Differential↗
The role of traditional healers in the treatment of toothache in Tanga Region, Tanzania.
The study was conducted in five villages in each of two districts in the Tanga Region of Tanzania. Seventy-three traditional healers and 408 villagers of 14 years and above (selected through systematic random sampling) were interviewed. Most of the traditional healers had practised for more than ten years and the majority had been trained by their father or grandfather. Sixty per cent of the traditional healers claimed, that they treated dental patients with an average of three patients per month. A large variety of local herbs was used and about 40 per cent of the traditional healers claimed that they would refer the client to a modern health facility, if their treatment did not work. Half of the villagers interviewed had experienced toothache and 60 per cent of those who had experienced toothache within the last two years had sought treatment from traditional healers, where they had all been treated with local herbs. Relief was obtained for more than six months for 40 per cent of the patients, who sought this service. The establishment of modern emergency oral care in rural health centres and dispensaries did not influence the villagers' use of the traditional healers.
Adolescent↗
Temporal arteritis: a cough, toothache, and tongue infarction.
Temporal arteritis, the most common form of systemic vasculitis in adults, is a panarteritis that chiefly involves the extracranial branches of the carotid artery. The condition is illustrated in this article by the case of a 79-year-old woman with a dry cough, toothache, tongue infarction, and vision loss. The mean age of onset is 72 years and the disease rarely occurs in persons younger than 50 years. The most common presenting manifestations are headache, jaw claudication, polymyalgia rheumatica, and visual symptoms. Eighty-nine percent of patients have an erythrocyte sedimentation rate greater than 50 mm/h. However, about 40% of patients present with atypical manifestations, including fever of unknown origin, respiratory tract symptoms (especially dry cough), and large artery involvement. Familiarity with such unusual manifestations of temporal arteritis facilitates early diagnosis and treatment, thereby reducing the risk of vision loss.
Aged↗