Immune challenges upregulate the expression of cannabinoid receptors in cultured human odontoblasts and gingival fibroblasts / Los desafíos inmunológicos regulan la expresión de los receptores cannabinoides en cultivos de odontoblastos y fibroblastos gingivales humanos

ABSTRACT Odontoblasts and gingival fibroblasts play essential roles in the physiological and pathological processes of dental tissue. Cannabinoid receptors (CB1 and CB2) are involved in analgesia by modulating the función of calcium channels that inhibit the synthesis of some neurotransmitters. A better understanding of the physiology of these receptors would provide the possibility of using them as therapeutic targets in controlling dental pain. The aim of this study was to evaluate the presence and activity of cannabinoid receptors in human odontoblast-like cells (OLC) and human gingival fibroblasts (HGF). CB1 and CB2 transcription was analyzed by real-time PCR, proteins were detected by immunofluorescence, and functional cannabinoid receptors were evaluated by measuring intracellular calcium concentration after stimulation with cannabidiol (CBD) and pre-treatment with a CB1 antagonist, a CB2 inverse agonist and a TRPV1 antagonist. Transcripts for CB1 and CB2 were found in both odontoblasts and gingival fibroblasts. Cannabidiol induced an increase in [Ca2+]i in both cells types, but surprisingly, pre-treatment with selective cannabinoid antagonists attenuated this effect, suggesting a functional communication between specific cannabinoid receptors and other CBD target receptors. In conclusion, human odontoblasts and gingival fibroblasts express functional CB1 and CB2 cannabinoid receptors, which could be modulated to improve the treatment of pain or dental sensitivity.

RESUMEN Los odontoblastos y los fibroblastos gingivales desempeñan funciones esenciales en los procesos fisiológicos y patológicos de los tejidos dentales. Los receptores cannabinoides (CB1 y CB2) participan en la analgesia mediante la modulación de la función de canales de calcio que inhiben la síntesis de algunos neurotransmisores. Un mejor conocimiento de su fisiología abre la posibilidad de utilizar estos receptores como dianas terapéuticas en el control del dolor dental. Este trabajo tuvo como objetivo evaluar la presencia y la actividad de los receptores cannabinoides en células humanas similares a los odontoblastos (OLC) y en fibroblastos gingivales humanos (HGF). Se analizó la transcripción de CB1 y CB2 por PCR en tiempo real, la detección de las proteínas por inmunofluorescencia y se evaluaron los receptores cannabinoides funcionales midiendo las concentraciones de calcio intracelular, tras la estimulación con cannabidiol (CBD) y el pretratamiento con un antagonista de CB1, un agonista inverso de CB2 y un antagonista de TRPV1. Se encontraron mensajeros para CB1 y CB2 tanto en odontoblastos como en fibroblastos gingivales. El cannabidiol indujo un aumento de la [Ca2+]i en ambos tipos de células, pero sorprendentemente el pretratamiento con antagonistas cannabinoides selectivos atenuó este efecto, lo que sugiere una comunicación funcional entre receptores cannabinoides específicos y otros receptores diana del CBD. En conclusión, los odontoblastos humanos y los fibroblastos gingivales expresan receptores cannabinoides CB1 y CB2 funcionales, que podrían ser modulados para mejorar el tratamiento del dolor o la sensibilidad dental.

Prevalência de dor odontogênica em um serviço de pronto-atendimento odontológico público do Sul do Brasil / Prevalence of odontogenic pain in a public dental urgency service in Southern Brazil

Objetivo: Identificar as principais causas de dor odontogênica que levam à busca pelo atendimento no Serviço de Pronto Atendimento Odontológico (SPAO) da Faculdade de Odontologia da Universidade de Passo Fundo (UPF), que funciona junto ao Hospital São Vicente de Paulo e está ligado ao Sistema Único de Saúde (SUS). Métodos: Realizou-se um estudo epidemiológico transversal e retrospectivo, baseado em dados de prontuários odontológicos de pacientes atendidos entre novembro de 2016 e outubro de 2017. Os dados foram analisados buscando-se a prevalência das diversas origens de dor odontogênica dos pacientes atendidos no período: pulpar (pulpite reversível, pulpite irreversível, necrose); periapical (pericementite, abscesso periapical); ou periodontal (periodontite, abscesso periodontal). Além disso, foi catalogada a conduta realizada durante os atendimentos de urgência. Resultados: Ao todo, foram analisados 1.275 prontuários. Desses, 868 pacientes (68,1%) apresentavam dor ao atendimento. Dos pacientes que relataram dor, 62,3% apresentavam dor odontogênica pulpar; 11,1%, dor periapical; e 12,2%, dor periodontal. A conduta mais adotada para tratamento da dor foi a terapia com analgésicos e/ou antibióticos (21,0% dos casos), seguida por acessos endodônticos (18,7%) e exodontias (17,9%). Conclusão: No serviço de pronto atendimento analisado, prevaleceram os casos de dor de origem pulpar. Os resultados obtidos contribuem para o desenvolvimento de estratégias de controle da dor odontogênica, bem como para a melhoria dos protocolos clínicos adotados na faculdade em questão (AU).

Objective: To identify the main causes of odontogenic pain that lead to people search for care in the Urgency Service of the School of Dentistry of University, Passo Fundo/RS/Brazil (SPAOH), localized in the Hospital São Vicente de Paulo. Methodology: A cross-sectional and retrospective study, carried out between the period from November 1, 2016 to October 31, 2017, when data from dental care records were collected and tabulated. The data were analyzed looking for the prevalence of several causes of odontogenic pain, with pulp origin (reversible, irreversible pulpitis, necrosis); periapical (pericementitis, abscess); periodontal (periodontitis); and others, in addition to the conduct performed in attendance. Results: A total of 1,275 dental records were analyzed, involving 868 patients, of which 68.1% reported the presence of pulp (62.3%), periapical (11.1%) and periodontal (12.2%) odontogenic pains. Analgesic or antibiotic therapies were the most common approaches, totaling 21.0% of cases, followed by endodontic accesses (18.7%) and extractions (17.9%). Conclusion: In the studied dental urgency service, cases of pulp pain prevail. The results obtained contribute to the development of strategies to control odontogenic pain, as well as to the improvement of clinical protocols (AU).

Construcción y validación de cuestionario para el análisis del miedo al dolor dental en pacientes odontológicos / Construction and validation of a questionnaire for the analysis of fear and pain in dental patients

La naturaleza urgente del dolor se relaciona más con el miedo que genera que con la verdadera intensidad de la molestia. El miedo al dolor dental obliga a muchos pacientes a reducir sus visitas al odontólogo hasta que experimentan una odontalgia insoportable, lo que pone en riesgo su salud general y dental. Un cuestionario constituye un medio efectivo para determinar la capacidad física y emocional de un paciente para tolerar un procedimiento odontológico. Cuando conoce el origen del miedo, el odontólogo dispone de técnicas para el manejo del paciente. Los objetivos son: medir el miedo al dolor dental; conocer las diferencias en el grado de miedo al dolor; identificar las situaciones cotidianas de la consulta dental que provocan un alto grado de miedo al dolor dental. Para cumplir los objetivos se propone el uso del Cuestionario del Miedo al Dolor Dental (CMDD), que se aplicó a 200 pacientes de la clínica de Endodoncia de la UMSNH. Material y métodos: 250 cuestionarios, bolígrafo. Se entregó el cuestionario de autoevaluación y se procedió al análisis y clasificación de la información con el software SPSS versión 18. Conclusiones: Se comprueba la fiabilidad del CMDD, es decir, que mide de manera confiable el miedo al dolor dental de los pacientes a los que se les aplica. Los resultados proveen información importante para identificar áreas para la mejora de la práctica odontológica relativas al manejo del miedo al dolor dental (AU)

The urgent nature of pain is more related to the fear generated than the true intensity of the discomfort. The fear of dental pain forces many patients to reduce their visits to the dentist until they experience an excruciating toothache. The assessment in dentistry determines the physical and emotional capacity of a patient to tolerate a dental procedure. A form with a questionnaire is an effective means of ensuring relevant information. When you know the origin of the fear of his patient, the dentist has many useful techniques for treatment. Objectives: The purpose of this study is to measure the fear of dental pain (I), know the differences that may exist in the degree of fear of pain between one individual and another (II) and everyday situations of dental consultation result in a high degree of fear of pain (III); using the Questionnaire of Fear for Dental Pain (QFDP) used in 200 patients of the Endodontics Clinic at UMSNH. Material and methods: 250 questionnaires. Selfassessment Questionnaire is delivered. We proceed to the analysis and classification of the information with the computer software SPSS version 18. Conclusions: The reliability of the CMDD is verified, that is, it reliably measures the fear of dental pain of the patients to whom it is applied. The results provide important information to identify areas for the improvement of dental practice related to the management of fear of dental pain (AU)

Pharmacological Synergism: A Multimodal Analgesia Approach to Treat Dental Pain / Sinergismo Farmacológico: Un enfoque de analgesia multimodal para el manejo de dolor dental

Abstract Dental pain is usually managed by clinical interventions and pharmacological coadjuvants such as NSAIDs. However, its perception and modulation is mediated by different nociceptive mechanisms and these strategies can be insufficient. The multimodal analgesia refers to the use of 2 or more analgesic drugs that attenuate or blockade different mechanisms of pain, obtaining a greater clinical effect. Within this concept, pharmacological synergism plays a leading role, combining different molecules in lower doses to diminish also side effects. Since there are no standard prescriptions to be use in all the patients, multimodal approaches allow the clinician to make responsible effective combinations, individualizing analgesia as the pathway to success.

Resumen El dolor dental generalmente se trata con intervenciones clínicas y coadyuvantes farmacológicos como los AINEs. Sin embargo, su percepción y modulación está mediada por diferentes mecanismos nociceptivos y estas estrategias pueden ser insuficientes. La analgesia multimodal se refiere al uso de 2 o más fármacos analgésicos que atenúan o bloquean diferentes mecanismos de dolor, obteniendo un mayor efecto clínico. Dentro de este concepto, el sinergismo farmacológico juega un papel importante, combinando diferentes moléculas en dosis más bajas para disminuir también los efectos secundarios. Dado que no hay prescripciones estándar para ser usadas en todos los pacientes, los enfoques multimodales permiten al clínico realizar combinaciones responsables y eficaces, individualizando la analgesia como el camino hacia el éxito.

COX-2 Inhibitors in Dental Pain Management / Inhibidores de la COX-2 en el Tratamiento del Dolor Dental

ABSTRACT: Pain is a major symptom in many dental procedures. Studies show consistently that pain, including dental pain, is not effectively treated; management of pain is a critical and challenging component in dentistry. Improvement and efficacy on the treatment depends on knowing which treatments are the most effective. Knowing how well an analgesic works and its associated adverse effects is fundamental to clinical decision. The aim of this review is to provide information to the dentistry field on the treatment of dental pain specifically with COX-2 inhibitors providing a useful guide to dentist on controlling pain. Therefore, nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed analgesic agents in surgical outpatients. Major limitations of NSAIDs are their gastrointestinal (GI) adverse events (perforation, ulceration, and bleeding), impairment of hemostatic function, and renal failure (with long-term therapy). A new class of NSAIDs, COX2 selective inhibitors (Coxibs), have been developed with the aim of reducing the GI adverse events of traditional NSAIDs while maintaining their effective anti-inflammatory and analgesic properties.

RESUMEN: El dolor es un síntoma principal en muchos procedimientos dentales. Los estudios demuestran consistentemente que el dolor, incluido el dolor dental, no se trata de manera efectiva; el manejo del dolor es un componente crítico y desafiante en odontología. La mejora y la eficacia en el tratamiento depende de saber qué tratamientos son los más efectivos. Saber qué tan bien funciona un analgésico y sus efectos adversos asociados es fundamental para la decisión clínica. El objetivo de esta revisión es proporcionar información al campo de la odontología sobre el tratamiento del dolor dental específicamente con los inhibidores de la COX-2, proporcionando una guía útil para el control del dolor por parte del dentista. Por lo tanto, los fármacos antiinflamatorios no esteroideos (AINE) son los agentes analgésicos más comúnmente prescritos en pacientes ambulatorios quirúrgicos. Las principales limitaciones de los AINE son los eventos adversos gastrointestinales (perforación, ulceración y hemorragia), deterioro de la función hemostática e insuficiencia renal (con terapia a largo plazo). Una nueva clase de AINE, los inhibidores selectivos de la COX-2 (Coxibs), se han desarrollado con el objetivo de reducir los eventos adversos gastrointestinales de los AINE tradicionales mientras se mantienen sus propiedades antiinflamatorias y analgésicas efectivas.

Apical surgery as cystic lesion treatment for barodontalgia prevention: a case report / Cirugía apical como tratamiento de lesión quística para prevenir la barodontalgia: informe de caso

ABSTRACT Barodontalgia is not a pathology but a symptom of a subclinical oral problem that, although rare, may affect patients subjected to atmospheric pressure changes and have an influence on flights. This paper aims to discuss the clinical characteristics of pathologies related to the etiology of barodontalgia, as well as differential diagnoses, treatments, and prevention. This paper reports a case of a Brazilian air force officer who went to the Santos Dumont Air Force Dental Clinic reporting pain in the anterior maxillary during a flight. An endodontic treatment followed by periradicular surgery was performed, in order to quickly seal the bone lesion and to avoid new cases of barodontalgia. This work demonstrated a successful approach of a periradicular lesion solved by surgical treatment in order to avoid new cases of barodontalgia during flights. In addition, this paper highlights the importance of deepening knowledge on this event and the need for periodic oral and dental assessment, as well as conclusive treatment in aircrew members in order to prevent aircraft accidents.

ABSTRACT La barodontalgia no es una patología en sí misma, sino un síntoma de un problema oral subclínico que, si bien es poco frecuente, puede afectar a pacientes sometidos a cambios en la presión atmosférica y afectar la seguridad de los vuelos. Este artículo pretende analizar las características clínicas de las patologías relacionadas con la etiología de la barodontalgia, así como los diagnósticos diferenciales, los tratamientos y la prevención. Se presenta el caso de un agente de la fuerza aérea brasileña que acudió a la Clínica Dental de la Fuerza Aérea Santos-Dumont reportando dolor en el maxilar anterior durante un vuelo. Se realizó un tratamiento de endodoncia seguido de cirugía perirradicular, con el fin de sellar rápidamente la lesión del hueso y evitar nuevos casos de barodontalgia. Este trabajo describe un procedimiento acertado para una lesión perirradicular resuelta por tratamiento quirúrgico para evitar nuevos casos de barodontalgia durante los vuelos. Además, destaca la importancia de profundizar en el conocimiento sobre este evento y la necesidad de llevar a cabo no solo una evaluación bucodental periódica de los miembros de las tripulaciones, además de ofrecerles tratamientos definitivos, con el fin de prevenir los accidentes aéreos.

Fatores associados à prevalência e intensidade de odontalgia em crianças de municípios da região de campinas, são paulo / Factors associated with the prevalence and intensity of dental pain in children in the municipalities of the campinas region, são paulo

RESUMO Objetivo: Avaliar a prevalência e a intensidade de odontalgia em crianças segundo porte populacional do município, fatores associados e absenteísmo. Métodos: A amostra constituiu-se de crianças de 12 anos provenientes de escolas públicas e privadas, sorteadas em oito cidades da região de Campinas (SP). Foi aplicado um questionário com dados de odontalgia, demográficos, socioeconômicos bem como foi realizado exame clínico para avaliar a experiência de cárie. Ter dor foi o desfecho para análise de regressão logística e a intensidade da dor para a regressão log-binomial negativa. Adotou-se nível de significância de 5%. Resultados: A amostra foi constituída de 1.233 crianças, sendo que 16,7% relataram dor nos últimos seis meses. A odontalgia foi causa de 46,4% do absenteísmo escolar nesse período. A prevalência de dor foi menor entre os de alta renda familiar (p=0,023) e maior entre não brancos (p=0,027). A intensidade da dor foi menor nos municípios de médio (p=0,02) e pequeno porte (p=0,004) e maior nas crianças cujos pais tinham menor nível de escolaridade (p=0,003), que procuraram o dentista por dor (p=0,04) e que apresentavam cárie não tratada (p=0,04). Conclusões: A prevalência e a intensidade da dor de dente em crianças de 12 anos estão relacionadas com aspectos socioeconômicos da família, como baixa renda e menor escolaridade dos pais, e causam impacto na atividade diária por meio do absenteísmo escolar. A intensidade foi menor em municípios de médio e pequeno porte. Estratégias de promoção de saúde bucal nessa faixa etária devem ser estimuladas para evitar a odontalgia.

ABSTRACT Objective: The aim of this study was to evaluate the prevalence and intensity of dental pain in children according to size of municipality, associated factors and absenteeism. Methods: The sample consisted of children aged 12 years old from public and private schools drawn from eight cities in the region of Campinas (SP). A questionnaire was applied to obtain dental pain, demographic, socioeconomic data, and a clinical examination was carried out to evaluate the experience of having a cavity. The outcome for the logistic regression analysis was having pain and the outcome for the negative log-binomial regression was the intensity of pain. The significance level was 5%. Results: The sample consisted of 1,233 children, and 16.7% reported pain in the last six months. Dental pain was the cause of 46.4% of school absenteeism during this period. The prevalence of pain was lower among households with high income (p=0.023) and higher among nonwhites (p=0.027). Pain intensity was lower in medium-sized cities (p=0.02) and small cities (p=0.004), and higher in children whose parents had a lower educational level (p=0.003), children who sought out a dentist for the pain (p=0.04) and who had untreated cavities (p=0.04). Conclusions: The prevalence and intensity of dental pain in children aged under 12 are related to socioeconomic aspects of the family, such as low-income and parents with a low level of education, which impact daily activities as seen through school absenteeism. Pain intensity was lower in medium and small cities. Oral health promotion strategies in this age group should be encouraged to avoid dental pain.

Preventive Analgesia: An Evidence-Based Alternative for Dentistry

he effective management of pain in dentistry increases the patient satisfaction, improves the treatment outcome and reduces the cost of care. To achieve this goal, different strategies are available for the administration of analgesics, such as preventive analgesia. The aim of this approach is to minimize sensitization induced by noxious perioperatory stimuli (both pre, intra and postoperatory). Available research support the favorable effect of preventive analgesia, although it also recognizes an important lack of high quality evidence to confirm its advantages. This new perspective article summarizes the preventive analgesia protocol, and its potential use in dentistry.

l manejo eficaz del dolor en odontología aumenta la satisfacción del paciente, mejora los resultados del tratamiento y reduce el costo de la atención. Para alcanzar esta meta, existen diferentes estrategias en la administración de analgésicos, como la analgesia preventiva. El objetivo de este enfoque es minimizar la sensibilización inducida por los estímulos perioperatorios nocivos (tanto pre, intra y postoperatorios). Los estudios apoyan el efecto favorable de la analgesia preventiva, aunque también reconocen una importante carencia de evidencia de alta calidad para confirmar sus ventajas. Este artículo de nueva perspectiva resume el enfoque de la analgesia preventiva y su potencial uso en odontología.

Automedicación analgésica en pacientes que acuden al servicio de odontología del Hospital General Dr. Luis Razetti, Barinas Estado Barinas, Venezuela / Analgesic self-medication on patients attending General Hospital Dr. Luis Razetti's dental care service in Barinas state Barinas, Venezuela

La automedicación consiste en el uso de medicamentos por decisión propia o consejo no cualificado. La automedicación con fármacos analgésicos puede retrasar el diagnóstico, prolongar la enfermedad y llevar al uso inadecuado de estos medicamentos. En la población general esta conducta es ampliamente investigada; sin embargo, la información es escasa en pacientes odontológicos. El objetivo fue analizar las características de la automedicación analgésica en pacientes que acuden al Servicio de Odontología del Hospital General Dr. Luis Razetti. Barinas estado Barinas, Venezuela. Se realizó una investigación descriptiva de diseño transversal, en la que se aplicó un cuestionario a pacientes que acudieron al servicio durante los meses septiembre y octubre del año 2015. El análisis de los resultados reveló 84,8% de pacientes automedicados, predominio del género femenino (65,3%) y del nivel de instrucción secundario (55,8%); el principal motivo de consulta fue el dolor dental (43,2%). Los analgésicos más utilizados fueron acetaminofén (45,3%) e ibuprofeno (42,1%), la motivación más frecuente fue el consejo de amigos y familiares (57,9%) y el 38,9% de los pacientes considera la intolerancia gastrointestinal como efecto adverso potencial de los analgésicos. El nivel de instrucción se relacionó significativamente con el conocimiento sobre automedicación y la dosis del analgésico (p<0,05); también hubo asociación entre el tipo de analgésico y la dosis referida (p<0,05). Se concluye que la automedicación analgésica es frecuente en pacientes que solicitan atención odontológica, por tanto es importante que el personal odontológico esté informado sobre las características de esta práctica y las consecuencias negativas que puede ocasionar.

Self-medication is defined as the use of medicines on one's own decision, without a doctor's prescription. Self-medication can cause analgesic misuse it may also delay the illnesses diagnosis and prolong them. This behavior is widely investigated in the general population, however, the information is limited in dental patients. This investigation was primarily focused in the analysis of aspects related to self-medication using analgesics on patients attending General hospital Dr. Luis Razetti's dental care service in Barinas, state Barinas, Venezuela. A cross-sectional descriptive study was done by means of a questionnaire applied to dental service patients on September and October 2015. Results analysis revealed that 84, 8% of patients were self-medicated, with predominance of females (65,3%) with secondary education level (55,8%). As well, dental pain was found as the main reason for the consultation (43,2%). Most commonly analgesics were Acetaminophen (45, 3%) and Ibuprofen (42,1%). Main motivations came from friends or relatives advice (57,9%). Moreover, 38, 9% of the patients consider the gastrointestinal intolerance as a potential adverse effect of analgesics. The level of education was significantly related to the knowledge about self-medication and its dose (p<0, 05); there was also an association between the type of analgesic and the referred dose (p<0, 05). It is concluded that analgesic self-medication is frequent in patients requiring dental care attention, therefore, it is important that dental staff is informed about the characteristics of this practice and its negative consequences.

Cross-Cultural Adaptation Of Modified Dental Pain Screening Questionnaire (M-Depaq) In A Primary Dental Care Clinic In Kuala Lumpur

A validated screening tool for patient triage based on the pain symptoms, could potentially optimize the resources and expertise available in dental pain management. The aim of this study was to translate and validate the Modified Dental Pain Questionnaire (M-DePaQ) for use in categorizing patients with pain into three groups of common dental conditions. Forward Malay and Chinese translation was performed, followed by backward English translation. The translation was reviewed by an expert panel and pre-tested on patients who are native speakers. Consecutive patients aged 18 years and older experiencing pain and attending the primary dental care clinic completed the questionnaires. Four calibrated dentists made clinical diagnoses independent of the questionnaire responses. For data analysis, the cases were split randomly into Random Sample 1 (RS1) and Random Sample 2 (RS2). Discriminant analysis was performed on RS1 to develop a model for classifying dental pain cases into three groups. The model was applied to cases in RS2, and a crossvalidated accuracy rate was obtained. Criterion validity was assessed using measures such as sensitivity, specificity, positive predictive value, and kappa. Of the 234 questionnaires distributed, 216 (92.3%) were returned. Classification rates were recorded at 73.8% for RS1, 75.0% for RS2, and 71.1% for all cases. The sensitivity values were 0.72, 0.39, and 0.43 for Groups 1, 2, and 3, respectively. The corresponding specificity values were 0.42, 0.87, and 0.94. The discriminant validity of the adapted questionnaire was satisfactory, but the criterion validity could not be established because of biases incorporated in the study.

Dental pain and its impact on quality of life among indigenous adolescents of Himalayas (Ladakh), India.

Background: Ladakh has less than optimal oral health care services and a poor transport and connectivity with other areas of the country during most part of the year. Therefore, immediate address to any dental pain is not possible. This study aims to determine the prevalence of dental pain among 12–15-year-old schoolchildren of Leh, Ladakh after the commutation impairing time of the year. Materials and Methods: A cross-sectional study was conducted in May 2014 to determine the prevalence and impact of dental pain among adolescents residing in Leh, Ladakh. A total of 264 students in the age group of 12–15 years participated in the study. The data were obtained using a pretested questionnaire that elicited information on past experience (6 months) of dental pain and the resultant impact on their daily lives. Statistical Analysis Used: Descriptive statistics was used for distribution of frequencies. Results: The response rate was 75.7%. Seventy-seven percent of the students reported dental pain in the past 6 months. About 89% of the students reported, at least, one impact due to dental pain. Females reported more than their male counterpart. Difficulty in eating was found to be commonly reported impact followed by difficulty in sleeping. Conclusions: The prevalence of dental pain and its impact was found to be high. There is a need for a paradigm shift in focus of oral health services from urban areas to remote and rural areas. Knowledge about the magnitude of dental pain can be used to evaluate and plan preventive and curative services in remote and rural areas.

Factors Related to the Unmet Dental Care Needs of Adults with Dental Pain / 치위생과학회지

The purpose of this study was to examine unmet dental care needs and related factors among adults in Korea. The study included a nationally representative sample of Koreans (Korea National Health and Nutrition Examination Survey 2104). The dependent variable was unmet dental care need and the independent variables were socioeconomic status and oral health status. The chi-square test and logistic regression analysis were performed to identify the associations between explanatory variables and unmet dental care needs. The major causes of unmet dental care needs included economic burden, work life, and academic reasons; in addition, dental treatment was considered to have lower priority. The factors that had statistically significant relationships with unmet dental care needs were sex, age, self-rated oral health status, and difficulty in mastication. The findings of the study, suggest a need for lower dental insurance copayments in keeping with the policies and principles aimed at strengthening the national health insurance system. In addition, groups with limited access to dental services should be identified, and effective health care policies and services should be established for these individuals.

Diagnosis and treatment of abnormal dental pain

Most dental pain is caused by an organic problem such as dental caries, periodontitis, pulpitis, or trauma. Diagnosis and treatment of these symptoms are relatively straightforward. However, patients often also complain of abnormal dental pain that has a non-dental origin, whose diagnosis is challenging. Such abnormal dental pain can be categorized on the basis of its cause as referred pain, neuromodulatory pain, and neuropathic pain. When it is difficult to diagnose a patient's dental pain, these potential alternate causes should be considered. In this clinical review, we have presented a case of referred pain from the digastric muscle (Patient 1), of pulpectomized (Patient 2), and of pulpectomized pain (Patient 3) to illustrate referred, neuromodulatory, and neuropathic pain, respectively. The Patient 1 was advised muscle stretching and gentle massage of the trigger points, as well as pain relief using a nonsteroidal anti-inflammatory and the tricyclic antidepressant amitriptyline. The pain in Patient 2 was relieved completely by the tricyclic antidepressant amitriptyline. In Patient 3, the pain was controlled using either a continuous drip infusion of adenosine triphosphate or intravenous Mg2+ and lidocaine administered every 2 weeks. In each case of abnormal dental pain, the patient's diagnostic chart was used (Fig.2 and 3). Pain was satisfactorily relieved in all cases.

Dental pain prevalence among health care personnel / Prevalência de dor dentária em trabalhadores da saúde

ABSTRACT BACKGROUND AND OBJECTIVES: Dental pain is a major reason for looking for dental services. Toothache may prevent or impair daily activities, such as working, having fun or socializing. This study aimed at evaluating dental pain prevalence in the last six months, among employees of the Teaching Hospital, Vitoria, ES. METHODS: This was an analytical, observational cross-sectional study. Data were collected by six trained interviewers by means of standardized interviews filling a questionnaire previously used by other studies about toothache among employees of the state of Espirito Santo, which included demographic and social information, as well as toothache report, type of pain (spontaneous or induced), use of dental services and employment bond. Confidence level of 95%, error of 5% and expected prevalence of 50% were used for sample calculation. Final sample was made up of 265 employees. The association between studied variables and dental pain prevalence was observed using Pearson Chi-square test with significance level of 5%. Odds Ratio and respective confidence intervals (CI- 95%) were estimated for statistically significant variables. RESULTS: Dental pain prevalence was 65.7%. Employees with up to 39 years of age (p=0.004, OR=2.081 CI 95%=1.226; 3.530), of economic classes C and D (p=0.007, OR=1.968 CI 95%=1.173; 3.30) and those receiving up to three minimum wages have reported higher dental pain prevalence (p=0.000, OR=2.829 CI=1.611; 4.967). CONCLUSION: There has been high dental pain prevalence among employees. Strategies to decrease such event should be implemented aiming at improving quality of life of such employees. .

RESUMO JUSTIFICATIVA E OBJETIVOS: A dor de origem dental é um dos principais motivos da utilização de serviços odontológicos. A dor de dente pode impedir ou dificultar atividades diárias, tais como trabalhar, se divertir e se relacionar com outras pessoas. O objetivo deste estudo foi verificar a prevalência de dor de origem dental nos últimos seis meses em funcionários do Hospital Universitário, Vitória, ES. MÉTODOS: Foi realizado um estudo analítico, do tipo observacional com delineamento transversal. Seis entrevistadores treinados coletaram os dados pelo método de entrevista padronizada preenchendo um questionário previamente utilizado em outros estudos sobre dor de dente em trabalhadores capixabas que incluía informações demográficas e sociais dos participantes, bem como o relato de dor de dente, tipo de dor (espontânea ou provocada), utilização de serviços odontológicos e tipo de vínculo empregatício. Para o cálculo amostral, os parâmetros utilizados foram nível de confiança de 95%, erro de 5% e prevalência esperada de 50%. A amostra final foi de 265 funcionários. A associação entre as variáveis do estudo e a prevalência de dor de dente foi verificada por meio do teste Qui-quadrado de Pearson com nível de significância de 5%. Estimaram-se os valores do Odds Ratio e respectivos intervalos de confiança (IC-95%) para as variáveis com significância estatística. RESULTADOS: A prevalência de dor de origem dental foi de 65,7%. Funcionários com até 39 anos (p=0,004, OR=2,081 IC95%=1,226;3,530), inseridos nas classes econômicas C e D, (p=0,007, OR=1,968 IC 95%=1,173;3,30) e aqueles que recebiam até 3 salários mínimos relataram maior prevalência de dor de origem dental (p=0,000, OR=2,829 IC=1,611;4,967). CONCLUSÃO: Observou-se alta prevalência de dor de dente em funcionários. Estratégias direcionadas à redução do evento devem ser implementadas com vistas à melhora da qualidade de vida desses trabalhadores. .

Association between dental pain and absenteeism among public workers from Southeastern Brazil / Associação entre dor de dente e absenteísmo em funcionários públicos do sudeste do Brasil

BACKGROUND AND OBJECTIVES: Studies carried out worldwide have shown that the incidence of dental pain is one reason leading people to look for dental services and that it impairs quality of life. This study aimed at observing the prevalence of dental pain, pain-related absenteeism and possible associations with sociodemographic characteristics. METHODS: This was an analytical, observational and transversal study using a randomized sample of 312 public servants obtained from a universe of 994 employees of the City Hall of Marataízes, ES. A structured script with 27 items was used for data collection, which was carried out between May and June 2009, by three qualified servants. Chi-square and Fisher Exact tests were used to compare dental pain percentages and absenteeism to sociodemographic factors. RESULTS: The prevalence of dental pain among employees was 57.0%, with higher prevalence among those with socioeconomic condition C/D/E (OR= 1.560). From those reporting dental pain, 17.8% have missed work, with higher prevalence of those of socioeconomic condition C/D/E (OR= 3.816) and with incomplete high school (OR= 2.298). CONCLUSION: High dental pain prevalence was observed and enough to produce absenteeism, with higher frequency among workers of less favored economic classes and with lower education level...

JUSTIFICATIVA E OBJETIVOS: Pesquisas realizadas em todo o mundo demonstram que a ocorrência de dor de dente é uma das razões que levam as pessoas a procurar o serviço odontológico, comprometendo a qualidade de vida. O objetivo deste estudo foi verificar a prevalência da dor dentária, absenteísmo motivado pela dor e possíveis associações com características sociodemográficas. MÉTODOS: Estudo analítico, observacional, transversal utilizou uma amostra aleatória de 312 servidores obtida de um universo de 994 funcionários da Prefeitura do município de Marataízes, ES. Foi utilizado um roteiro estruturado com 27 itens para a coleta de dados, realizada entre maio e junho de 2009, por três servidoras treinadas. Para comparação dos percentuais de dor dentária e absenteísmo com os fatores sociodemográficos foram utilizados os testes Qui-quadrado e Exato de Fisher. RESULTADOS: A prevalência de dor dentária entre os funcionários foi de 57,0%, com maior prevalência naqueles com condição socioeconômica C/D/E (OR=1,560). Dos que sentiram dor dentária, 17,8% faltaram ao trabalho, com maior prevalência para os de condição socioeconômica C/D/E (OR=3,816) e com escolaridade até o ensino médio incompleto (OR= 2,298). CONCLUSÃO: Alta prevalência de dor de dente foi observada e suficiente para produzir absenteísmo, com maior frequência em trabalhadores inseridos nas classes econômicas menos favorecidas e com menor escolaridade...

Dental hot cold sensitivity and traumatic dental injuries

AIM: Although several studies have indicated negative impacts of traumatic dental injuries on children’s quality of life, virtually none of them have explored the possible association between them and the occurrence and dental hot cold sensitivity. The aim of this study was to study the possible association of hot cold dental sensitivity and history of traumatic dental injuries. MATERIAL AND METHODS: A cross sectional study involving a representative sample of 11 to 14 year old schoolchildren from 13 Brazilian municipalities was carried out. Data on traumatic dental injuries were collected through oral exanimations. Non clinical data were obtained through structured interviews on socio demographic profile and prevalence of dental hot cold sensitivity. Non conditional logistic regression analysis was performed for the presence of dental hot cold sensitivity controlled for gender, maternal schooling and history of dental caries. RESULTS: The prevalence of dental hot cold sensitivity was 30.3% and the prevalence of traumatic dental injuries was 16.6%. School children presenting traumatic dental injuries had 22% higher prevalence of dental hot cold sensitivity compared to those without it regardless other studied variables. CONCLUSIONS: A significant and independent association between dental hot cold sensitivity and history of traumatic dental injuries was observed.

Dor de dente como preditor de absenteísmo em trabalhadores de uma indústria de sucos da Região Sudeste do Brasil / Dental pain as a predictor of absenteeism among workers in a juice factory in southeastern Brazil

Dor é um problema de saúde pública, responsável pela perda de dias de trabalho. O objetivo deste artigo é analisar a prevalência da dor dentária, a ocorrência de absenteísmo e suas possíveis associações com características sociodemográficas. Este estudo transversal utilizou uma amostra aleatória de 169 sujeitos de um universo de 666 funcionários. Dados foram coletados por pesquisadora treinada utilizando roteiro estruturado. O teste exato de Fisher avaliou as possíveis associações; a força da associação avaliada pelo Odds Ratio com significância de 5%. A prevalência de dor dentária foi de 46,7% e a de absenteísmo 12,7%. Não houve associação estatística entre dor e as variáveis avaliadas - sexo, faixa etária, renda e escolaridade. Em relação ao absenteísmo, indivíduos com grau de escolaridade até o ensino médio incompleto declararam maior perda de horas de trabalho (OR = 8,850, IC95% = 2,114; 37,046). A prevalência de dor foi expressiva e não esteve associada às variáveis controladas neste estudo. A dor de dente observada foi capaz de produzir absenteísmo, e este esteve associado à escolaridade dos participantes. A realização de exames periódicos odontológicos deve ser incentivada para diagnóstico e intervenção precoce, minimizando episódios de dor de dente.

Pain is a public health problem responsible for loss of work days. The scope of this article is to analyze the prevalence of dental pain and absenteeism, and the possible association with social and demographic characteristics. This cross-sectional study involved a random sample of 169 individuals selected from a universe of 666 workers. Data was collected by a trained researcher using a structured questionnaire. Fisher's Exact Test verified the possible associations; the strength of the associations was verified by the Odds Ratio with 5% significance. The prevalence of dental pain was 46.7%, and absenteeism 12.7%. There was no association between dental pain and the variables analyzed, namely sex, age, income and education. With respect to absenteeism, the individuals with less years of instruction declared greater loss of work hours (OR = 8.850, IC95% = 2.114; 37.046). The prevalence of pain was considerable and was not associated with the controlled variables of this study. Dental pain observed was sufficient to lead to absenteeism, and this was associated with education. Periodic exams must be encouraged for diagnosis and early intervention, thereby minimizing episodes of dental pain.

Odontalgia associada a variáveis socioeconômicas, psicossociais e saúde bucal / Dental pain associated with socioeconomic status, psychosocial factors and oral health

JUSTIFICATIVA E OBJETIVOS: É importante conhecer os fatores associados à odontalgia para proporcionar uma adequada intervenção e atenção a este significante problema dos serviços de saúde. O objetivo do estudo foi conhecer a prevalência de odontalgia como motivo de última consulta odontológica de adolescentes de 15 anos e verificar sua associação com fatores socioeconômicos, variáveis comportamentais e saúde bucal. MÉTODO: A amostra probabilística contou com 592 alunos de 10 escolas estaduais. A variável odontalgia foi avaliada por questionário aplicado em ambiente escolar. O exame clínico bucal foi realizado segundo critérios da Organização Mundial de Saúde e as demais variáveis foram investigadas utilizando questionários autoaplicáveis. Os dados foram tabulados no Excel e a associação entre as variáveis foram avaliadas utilizando Odds Ratio. RESULTADOS: Do total de 592 participantes, 33,44% dos adolescentes relataram a dor de origem dentária como motivo da última consulta odontológica. Após análise estatística, a odontalgia foi associada à baixa renda (p = 0,04), ao maior número de pessoas residentes no mesmo domicílio (p < 0,01), a baixa frequência de escovação diária (p = 0,01), ao alto intervalo entre consulta odontológica (p < 0,001), ao maior período de tempo em que se deu a última consulta odontológica (p < 0,001), à ansiedade odontológica (p < 0,01), ao consumo de alimentos cariogênicos (p = 0,03) à alta experiência de cárie (p < 0,01) e à presença de lesão cariosa não tratada (p < 0,001). CONCLUSÃO: A odontalgia está relacionada com a experiência e atividade de cárie dentária e a fatores socioeconômicos e psicossociais, mostrando a necessidade de maior atenção com estas condições.

BACKGROUND AND OBJECTIVES: Knowing factors associated with dental pain is important to provide adequate intervention and attention to this major health care problem. This study aimed at understanding the prevalence of dental pain as reason for the latest dental appointment among 15-year old adolescents and at checking its association with socioeconomic factors, behavioral variables and oral health. METHOD: The probabilistic sample was made up of 592 students of 10 state schools. Dental pain variable was evaluated by questionnaires applied at the school. Clinical oral exam was performed according to World Health Organization's criteria and remaining variables were investigated by self-applicable questionnaires. Data were classified by the Excel program and Odds Ratio was used to associate variables. RESULTS: From 592 participants, 33.44% have reported dental pain as reason for their latest dental appointment. After statistical analysis, dental pain was associated with low income (p = 0.04), higher number of people living in the same home (p < 0.01), low frequency of daily tooth brushing (p = 0.01), long interval between dental appointments (p < 0.001), longer time elapsed since last dental appointment (p < 0.001), dental anxiety (p < 0.01), consumption of cariogenic food (p = 0.03), high dental caries experience (p < 0.01) and with the presence of untreated dental caries (p < 0.001). CONCLUSION: Dental pain is related to dental caries experience and activity and to socioeconomic and psychosocial factors, showing the need for further attention to these conditions.

Referred dental pain, an analysis of their prevalence and clinical implication / Dolor dental referido, análisis de su prevalencia e implicancias clínicas

The study objective was to evaluate the prevalence of referred dental pain (RDP) in a group of Brazilians subjects and identify possible partnerships with sex, age and the presence of periodontal or periapical lesions. A descriptive cross-sectional study was designed, 98 patients between 14 and 64 years old (59 women and 39 men), who consulted by dental pain were evaluated clinically and radiographically in order to determine the cause and partnership with periapical and periodontal lesions and its possible territories projection other than their origin. The prevalence of RDP was 31.6 percent, higher in women (67.74 percent) though without statistical significance. The RDP was presented at a 45.16 percent together with periapical lesion and a 25.8 percent along with periodontal lesion. There was no relationship between age and RDP presence. The high prevalence of RDP found reinforces the need for a diagnosis of orofacial pain.

El objetivo de este estudio fue analizar la prevalencia de dolor referido dental (DRD) en un grupo de sujetos brasileros y determinar las posibles asociaciones con sexo, edad y la presencia de lesión periapical o periodontal. Se diseñó un estudio descriptivo de corte transversal, con 98 pacientes, de entre 14 y 64 años (59 mujeres y 39 hombres), que consultaron por dolor dental, ellos fueron evaluados clínica y radiográficamente con el fin de determinar la causa y la asociación con lesión periapical y periodontal y su posible proyección a territorios distintos de su origen. La prevalencia del DRD fue de 31,6 por ciento, mayor en mujeres (67,74 por ciento) aunque sin significancia estadística. El DRD se presentó en un 45,16 por ciento junto con lesión periapical y un 25,8 por ciento junto a lesión periodontal. No se encontró asociación entre la edad y la presencia de DRD. La alta prevalencia de DRD encontrada refuerza la necesidad de un diagnóstico etiológico del dolor orofacial.

Dor dentária como motivo de absenteísmo em uma população de trabalhadores / Dental pain as the motive for absenteeism in a sample of workers

The aim of this study was to analyze the prevalence of dental pain, absenteeism induced by dental pain, and the association with socio-demographic characteristics. The research had a cross-sectional design using a random sample of 170 municipal employees from the City of Venda Nova do Imigrante, Espírito Santo state, Brazil, selected from a universe of 545 individuals. Data was collected using a 27-item questionnaire applied by a municipal worker. The comparison of dental pain and prevalence of absenteeism with socio-demographic and functional characteristics was verified using Fisher's Exact test. The research project was approved by an Ethics Research Committee. The prevalence of dental pain among the employees was 43% and half of these felt dental pains at work. Absenteeism related to dental pain was 23.4%. Workers with lower instruction level were twice as likely to have dental pain (OR = 2,144, IC95% = 1,141; 4,030). Male subjects (OR = 5,714, IC95% = 1,773; 18,416), less years of education (OR = 4,875, IC95% = 1,405; 16,909) and less family income (OR = 3,613, IC95% = 0,931; 14,021) were related with higher absenteeism caused by dental pain. High dental pain frequency revealed in this study indicates that health promotion policies are needed to improve the quality of life of workers.

O objetivo foi analisar a prevalência da dor dentária e a ocorrência de absenteísmo provocado por dor de dente e as possíveis associações com características sociodemográficas. Um estudo analítico de corte transversal foi realizado em uma amostra aleatória de 170 sujeitos de um universo de 545 funcionários da Prefeitura Municipal de Venda Nova do Imigrante (ES). Para a coleta de dados foi utilizado um roteiro de 27 itens aplicado por uma servidora municipal. Para comparação dos percentuais entre dor dentária e absenteísmo com os fatores sociodemográficos foi utilizado o teste exato de Fisher. A prevalência de dor dentária entre os trabalhadores foi de 43% e a de absenteísmo por dor dentária foi de 23,4%. Funcionários com grau de escolaridade até ensino médio incompleto relataram uma chance duas vezes maior de dor de dente (OR = 2,144, IC95% = 1,141;4,030) . Trabalhadores do sexo masculino (OR = 5,714, IC95% = 1,773;18,416), de escolaridade até ensino médio incompleto (OR = 4,875, IC95% = 1,405;16,909) e renda familiar até dois salários mínimos (OR= 3,613, IC95% = 0,931;14,021) apresentaram maior prevalência de absenteísmo associada à dor de dente. A prevalência de dor encontrada demonstra a necessidade de políticas de promoção de saúde bucal para melhorar a qualidade de vida dos trabalhadores.