Oximetría de pulso y su eficacia para diagnosticar vitalidad pulpar / Pulse oximetry and its use in diagnosing pulp vitality

Objetivo: Identificar y analizar en la literatura científica reciente el uso de la oximetría de pulso como método diagnóstico de vitalidad pulpar. Metodología: En este trabajo se llevó a cabo una revisión de la literatura en las plataformas de PubMed y Google Académico, en la cual se analizó el uso de la oximetría de pulso en el diagnóstico y monitoreo odontológico del estado pulpar. Resultados: Después de una exhaustiva revisión, y de acuerdo con los criterios de inclusión y exclusión, se analizaron 21 artículos. La mayoría de los trabajos consideran la oximetría de pulso un método alternativo de diagnóstico indoloro, seguro y eficaz; sin embargo, la adaptación de un instrumento de uso exclusivo odontológico es necesaria para una medición exacta de la saturación de oxígeno en la pulpa dental. Los avances tecnológicos en el campo clínico de la odontología nos han llevado a la búsqueda de nuevas técnicas diagnósticas clínicas para mejorar la atención y los tratamientos de los pacientes que acuden día con día a recibir una consulta odontológica. Conclusiones: En los últimos años la oximetría de pulso ha demostrado ser una herramienta de diagnóstico eficaz para el diagnóstico de la vitalidad pulpar. El análisis de los artículos incluidos en esta revisión concluye que la oximetría de pulso es una técnica innovadora que puede ser utilizada como una herramienta diagnóstica adyuvante en el diagnóstico de la vitalidad pulpar (AU)

Objective: To identify and analyze in the recent scientific literature the use of pulse oximetry as a diagnostic method for pulp vitality. Methodology: In this work, a literature review was carried out on the PubMed and Google Scholar platforms in which the use of pulse oximetry in the dental diagnosis and monitoring of pulp status was analyzed. Results: After an exhaustive review and in accordance with the inclusion and exclusion criteria, 21 articles were analyzed. Most of the studies consider pulse oximetry an alternative method of painless, safe and effective diagnosis, however, the adaptation of an instrument for exclusive dental use is necessary for an exact measurement of the oxygen saturation in the dental pulp. Technological advances in the clinical field of dentistry have led us to search for new clinical diagnostic techniques to improve the care and treatment of patients who come every day to receive a dental consultation. Conclusions: In recent years, pulse oximetry has proven to be an effective diagnostic tool for the diagnosis of pulp vitality. The analysis of the articles included in this review concludes that pulse oximetry is an innovative technique that can be used as an adjunct diagnostic tool in the diagnosis of pulp vitality (AU)

Accuracy of the dental pulp sensibility test using cold spray for the diagnosis of pulp diseases: an observational clinical study

The dental pulp sensibility test is one of the main auxiliary resources for the diagnosis of pulp pathologies, and its accuracy is still debatable. This cross-sectional observational study evaluated the accuracy of the pulp sensibility test (PST) using cold spray (1,1,1,2-tetrafluoroethane) for the diagnosis of pulp diseases and determined the effect of individual and clinical variables on the reliability of this test. The paper was designed following the STROBE statement. Sixty patients with indications for primary endodontic treatment were selected and examined from August 2017 to July 2018. Data collection was performed through interviews, clinical/radiographic examinations and the PST. The results of the cold test, along with data on sex, age, the tooth type regarding the root number, and the presence of restorations and caries, as well as the recent consumption of analgesics, were recorded. The presence of bleeding within the pulp chamber was used as the gold standard to compare with the clinical diagnosis and to identify the true-positive, false-positive, true-negative, and false-negative responses. The accuracy of PST achieved in subgroups of individual and clinical variables was compared using the chi-square test with a significance level of 5% (p < 0.05). The PST with the use of cold spray showed a sensitivity of 0.88, a specificity of 1.00, a positive predictive value of 1.00, a negative predictive value of 0.86, and an accuracy of 0.93. The accuracy of the cold spray was not affected by individual or clinical variables. The PST with the use of cold spray is an accurate and reliable method for determining the diagnosis of pulp diseases, especially in cases of pulp vitality or irreversible pulpitis.

Importancia semiológica del dolor durante etapas de un proceso inflamatorio pulpar / Semiological importance of pain during the stages of a pulpal inflammation process

RESUMEN Introducción: Existe la tentativa de realizar un diagnóstico del proceso inflamatorio pulpar, basado en el aspecto histopatológico, el cual es irreal pues no se puede comparar estos hallazgos con los clínicos. Resulta más objetivo y confiable, analizar las características del dolor que expresa la evolución pulpar en cada etapa y establecer un diagnóstico certero que permita precisar el tipo de tratamiento. Objetivo: Interpretar el curso de un proceso inflamatorio pulpar a través de las variables asociadas a estímulos nociceptivos. Métodos: Se realizó una revisión bibliográfica sobre las variables en relación con el dolor y su asociación con un estado inflamatorio pulpar. Se analizaron 24 artículos científicos en relación con el dolor pulpar, se escogieron 15 por ser los más afines al propósito perseguido, y todos corresponden a los últimos 5 años, publicados en revistas internacionales y nacionales. PubMed se utilizó como fuente fundamental de búsqueda; otras bases de datos también consultadas fueron Lilacs, Hinari y Medline. Análisis e integración de la información: Las condiciones pulpares se clasifican como: pulpitis reversible, transicional, irreversible y pulpa necrótica. La semiología del dolor se sustenta en cuatro variables básicas asociadas a los estímulos nociceptivos que son: cualidad del dolor pulpar puede ser punzante o continuo, su curso intermitente o continuo, su localización limitado a una región de la boca, irradiado y referido, y su intensidad considerada como leve, moderado o severo. Conclusiones: Las variables asociadas a los estímulos nociceptivos revisten importancia semiológica, pues permiten valorar las manifestaciones dolorosas por las que transita un proceso inflamatorio pulpar(AU)

ABSTRACT Introduction: Attempts have been made to diagnose the pulpal inflammatory process based on its histopathological features, but to no avail, for these findings cannot be compared with clinical results. It would be more objective and reliable to analyze the characteristics of the pain expressing the pulpal evolution at each stage and establish an accurate diagnosis allowing the choice of the type of treatment to be indicated. Objective: Interpret the course of a pulpal inflammatory process through variables associated to nociceptive stimuli. Methods: A bibliographic review was conducted about the study variables with respect to pain and its association to a pulpal inflammatory state. A total 24 scientific papers were analyzed which dealt with pulpal pain, of which 15 were selected for being the most closely related to the goal pursued and having been published in international and national journals in the last five years. PubMed was the main source searched, while other databases such as Lilacs, Hinari and Medline were also consulted. Data analysis and integration: Pulpal conditions are classified into reversible, transitional, irreversible pulpitis and necrotic pulp. Pain semiology is based on the following four basic variables associated to nociceptive stimuli: pulpal pain quality (sharp or continuous), course (intermittent or continuous), location (limited to a region in the mouth, radiating or referred) and intensity (mild, moderate or severe). Conclusions: The variables associated to nociceptive stimuli are semiologically important, for they make it possible to evaluate the painful manifestations gone through by a pulpal inflammatory process(AU)

Urgência em Endodontia: diagnóstico e tratamento em casos de pulpite irreversível sintomática / Urgency in Endodontics: Diagnosis and Treatment in Cases of Symptomatic Irreversible Pulpitis

Objetivo: discutir sobre o diagnóstico e a conduta terapêutica em casos de urgência endodôntica em dentes que apresentam pulpite irreversível sintomática. Material e Métodos: realizou-se uma revisão bibliográfica de estudos publicados nos últimos 5 anos (2015- 2020) por meio de busca nas bases de dados: PubMED, BVS (Biblioteca Virtual em Saúde) e Scielo (Scientific Eletronic Library). Para a pesquisa, foram utilizados os seguintes descritores: Pulpite Irreversível (Irreversible Pulpitis), Tratamento (Treatment), Dor (Pain) e Endodontia (Endodontics). Resultados: O diagnóstico é um passo fundamental no tratamento das urgências e emergências de origem endodôntica, pois é a partir do correto diagnóstico que será instituído o tratamento correto, reestabelecendo o conforto do paciente. Quando o profissional dispõe de tempo suficiente para realizar a remoção do tecido pulpar e o preparo do canal radicular, esse é o tratamento de escolha para os casos de pulpite irreversível sintomática, o qual pode ser realizado em sessão única ou em múltiplas sessões. Quando o profissional não dispõe de tempo suficiente para realizar o tratamento endodôntico convencional, a opção de tratamento é realizar apenas o atendimento de urgência para retirar o paciente do quadro de dor aguda presente, e em um momento futuro realizar o tratamento endodôntico completo. Conclusão: As urgências endodônticas sempre estão presentes nos consultórios odontológicos, os profissionais devem estar sempre preparados para realizar um correto diagnóstico e tratamento para cada caso, trazendo assim conforto ao paciente.

Objective: to discuss the diagnosis and therapeutic management in cases of endodontic urgency in teeth with symptomatic irreversible pulpitis. Material and Methods: a bibliographic review of studies published in the last 5 years (2015-2020) was carried out by searching the databases: PubMED, BVS (Virtual Health Library) and Scielo (Scientific Electronic Library). For the research, the following descriptors were used: Irreversible Pulpitis, Treatment, Pain and Endodontics. Results: The diagnosis is a fundamental step in the treatment of urgencies and emergencies of endodontic origin, as it is from the correct diagnosis that the correct treatment will be instituted, reestablishing the patient's comfort. When the professional has enough time to remove the pulp tissue and prepare the root canal, this is the treatment of choice for cases of symptomatic irreversible pulpitis, which can be performed in a single session or in multiple sessions. When the professional does not have enough time to carry out the conventional endodontic treatment, the treatment option is to perform only emergency care to remove the patient from the present acute pain condition, and at a future time to carry out the complete endodontic treatment. Conclusion: Endodontic emergencies are always present in dental offices, professionals must always be prepared to carry out a correct diagnosis and treatment for each case, thus bringing comfort to the patient.

Pulpitis crónica hiperplásica. presentación de un caso / Pulpitecrônica hiperplásica. apresentação de um caso / Chronichyperplastic pulpitis. case report

Se presentó un caso en la Clínica Estomatológica Ramón Guevara Montano de Baracoa, provincia Guantánamo, con diagnóstico de pulpitis hiperplásica a nivel del segundo premolar superior derecho (diente 15). El diagnóstico se realizó siguiendo los principios del método clínico y con apoyo de los medios auxiliares de diagnóstico. Se realizó biopulpectomía y la paciente evolucionó de forma satisfactoria al ser respetados los principios básicos de la endodoncia: diagnóstico, instrumentación biomecánica y obturación del conducto radicular en longitud y amplitud(AU)

A case at the Ramón Guevara Montano Stomatology Clinic in Baracoa, Guantánamo province, with diagnosis of hyperplastic pulpitis at the second upper right premolar (tooth 15) was presented. The diagnosis was made following the principles of the clinical method and support of diagnostic aids. Biopulpectomy was performed and the patient progress was satisfactory being respected the basic principles of endodontics: diagnosis, biomechanical instrumentation and closed of the canal or root in length and width(AU)

Um caso na Clínica de Estomatologia Ramón Guevara Montano em Baracoa, província de Guantánamo, com diagnóstico de pulpite hiperplásica no nível do segundo pré-molar superior direito (dente 15) foia presentado. O diagnóstico foi feito seguindo os princípios do método clínico e com o apoio de auxiliares de diagnóstico. A biopulpectomia foi realizada e o paciente evoluiu satisfatoriamente, respeitando-se os princípios básicos da endodontia: diagnóstico, instrumentação biomecânica e obturação do canal radicular em comprimento e amplitude(AU)

Enfermedades pulpares y periapicales en pacientes sistémicamente comprometidos en el Centro de Salud de Uayma, Yucatán, México / Pulp and periapical diseases in systemically compromised patients: Health Center of Uayma, Yucatan, Mexico

Introducción: el diagnóstico preciso de las enfermedades pulpares y periapicales es una fase en que se evalúan los factores sistémicos y locales. La diabetes es un ejemplo de enfermedad sistémica crónica degenerativa. En México en el 2012, se reportaron 418 797 casos, así como otras enfermedades asociadas, como son la hipertensión arterial y la insuficiencia renal. Objetivo: determinar la frecuencia de enfermedades pulpares o periapicales en pacientes sistémicamente comprometidos que acudieron al Centro de Salud de Uayma, Yucatán, México durante el 2013. Métodos: estudio descriptivo observacional. El universo fue de 689 pacientes. El muestreo fue no probabilístico, por conveniencia de 100 pacientes de 18 y más años de edad que presentaron alguna enfermedad sistémica y enfermedad pulpar o periapical. Bajo un consentimiento informado y voluntario se realizó, previa evaluación médica por el galeno adjunto, una historia dental, evaluación de los signos y síntomas de dolor, pruebas pulpares (térmicas y eléctricas), palpación y percusión y abordaje diagnóstico con tinción/transiluminación, así como la toma, examinación e interpretación de las imágenes radiográficas periapicales para confirmar el diagnóstico de enfermedades periapicales. Para el procesamiento de los datos se empleó la estadística descriptiva. Resultados: el 67 por ciento presentó enfermedades pulpares o periapicales. Se analizaron 106 órganos dentales, 41,5 por ciento manifestaron enfermedades pulpares y 58,5 por ciento periapicales; entre estas la más prevalente fue el absceso dentoalveolar crónico con 45,2 por ciento. La enfermedad sistémica que prevaleció fue la diabetes mellitus con 38 por ciento, la cual se presentó acompañada con hipertensión en 17 por ciento y con epilepsia en el 1 por ciento. De estos pacientes con diabetes mellitus, la enfermedad más frecuente fue la periapical con 53,6 por ciento. Conclusiones: en el paciente sistémicamente comprometido existe una frecuencia alta de las enfermedades pulpares y periapicales. La presencia de estas manifestaciones puede ser consecuencia de una respuesta de la pulpa dental ante la ausencia de un tratamiento odontológico oportuno y de la condición sistémica del paciente(AU)

Introduction: accurate diagnosis of pulpal and periapical diseases is a phase in which systemic and local factors are evaluated. Diabetes is an example of chronic degenerative systemic disease. In 2012, there were 418 797 cases as well as other associated diseases, such as hypertension and renal failure in Mexico. Objective: to determine the frequency of pulpal and periapical diseases in systemically compromised patients who attended the Health Center Uayma, Yucatan, Mexico in 2013. Methods: observational and descriptive study was conducted. The universe of study was 689 patients. A non-probabilistic, convenience sampling of 100 patients aged 18 and older, which had some kind of systemic disease and also pulpal or periapical disease. With the voluntary informed consent and a prior medical evaluation by the attending physician, a dental history, the assessment of pain signs and symptoms of pain, pulp testing (thermal and electrical), palpation and percussion and diagnostic approach with staining/transillumination were made as well as radiographic periapical images were taken, analyzed and interpreted to confirm the diagnosis of periapical diseases. Summary statistics was used for data processing. Results: sixty-seven percent of patients had pulpal or periapical diseases. One hundred and six dental organs were analyzed, 41.5 percent showed pulpal diseases and 58.5 percent periapical diseases, being the chronic dentoalveolar abscess with 45.2 percent the predominant one. Prevailing systemic disease was diabetes mellitus with 38 percent of cases, accompanied with hypertension in 17 percent and epilepsy in 1 percent of patients. In the diabetic patients, the most common disease was the periapical one for 53.6 percent. Conclusions: the systemically compromised patient faces highly frequent pulpal and periapical diseases. They may result from the response of the dental pulp to the lack of timely odontologic treatment and the systemic condition of the patient(AU)

Prevalence of endodontic diseases: an epidemiological evaluation in a Brazilian subpopulation

Aim: To determine the prevalence of pulp and periradicular diseases in a Brazilian subpopulation, correlating the prevalence with sex, age and most affected teeth. Methods: Data collected from medical records of patients treated at the Clinic of Specialization in Endodontics of the Federal University of Pernambuco between 2003 and 2010. The following variables were recorded for each patient: sex, age, affected teeth and diagnosed endodontic disease. Using Pearson's chi-square and Fisher's exact tests, the collected data analysis was set at a 5% significance level. Results: From all the treated teeth, 57% were diagnosed with pulp diseases, with the symptomatic irreversible pulpitis being the most prevalent (46.3%), while among the diagnosed periradicular diseases (43%), chronic apical periodontitis was the most prevalent (81%). Pulp diseases were detected in men and women in an unequal mode (p=0.008). Subjects under 40 years old had higher prevalence of pulp disease (p=0.286), and patients over 50 years were most affected by periradicular diseases (p=0.439). Maxillary incisors and mandibular first molars were the most affected teeth by endodontic diseases. Conclusions: In the evaluated subpopulation, the endodontic diseases were more prevalente in the maxillary incisive, affected indiscriminately individuals of different age groups and chronic apical periodontitis was the most prevalent diagnosed disease (Au)

Perception of discomfort during injection and the need for supplemental anesthesia in the intraosseous technique using 4 per cent articaine / Percepción de incomodidad durante la inyección y necesidad de anestesia suplementaria en anestesia intraósea usando articaína al 4

The authors conducted an experimental study to determine patient perception of discomfort during injection and the need for supplemental anesthesia using the intraosseous technique with 4% articaine with 1:100,000 epinephrine in patients with symptomatic pulpitis in mandibular molars. At different clinical sessions, researchers used 4% articaine with 1:100,000 epinephrine to apply intraosseous injection (Group 1) or inferior alveolar nerve block (Group 2). Each technique was applied in 35 patients. In each group, the need for additional anesthesia was determined and patient discomfort during injection was assessed with a Visual Analogue Scale (VAS) test. In the intraosseous group, no supplemental technique was needed in 22 patients (62.85 %), and results were similar for the inferior alveolar technique (n: 23 65.71%). The intraosseous technique proved to be more comfortable than the mandibular technique (18 patients - 25.7%). This study found that the use of intraosseous technique with 4% articaine shows promising results regarding patient comfort and reducing the need for additional anesthesia.

Los autores condujeron un estudio experimental para deter minar la eficacia de la técnica anestésica intraósea usando articaína al 4% con epinefrina 1:100.000, en pacientes con pulpitis aguda en molares mandibulares. En diferentes sesiones clínicas, los miembros del equipo de investigadores usaron articaína al 4% con epinefrina 1:100.000 para inducir anestesia mandibular con la técnica intraósea (Grupo 1) o con el bloqueo del nervio alveolar inferior (Grupo 2), se aplicó cada técnica en 35 pacientes con diagnóstico de pulpitis aguda en molares inferiores. En cada grupo, se determinó la necesidad de hacer anestesia complementaria y la comodidad del paciente con un test Escala Visual Analoga. Un total de 70 pacientes fueron enrolados en este estudio (35 sujetos por grupo). En el grupo de intraósea no fue necesaria la aplicación de técnicas complementarias en 22 pacientes (31.4%), resultados similares en la técnica alveolar inferior (n: 23 32.8%). La técnica intraósea demostró ser más cómoda al compararla con técnica mandibular (18 pacientes 25.7%). Este estudio demostró que el uso de la técnica intraósea conarticaína al 4%, arrojó resultados prometedores en lo que a comodidad y reducción en la anestesia complementaria hace referencia.

Lesión endoperiodontal combinada secundaria a un traumatismo incisal / Combined endoperiodontal injury secondary to trauma incisal

Introducción: en la práctica estomatológica, es frecuente encontrar situaciones clínicas en las que, en una somera exploración, no es fácil determinar si se trata de una afección endodóntica, periodontal o una combinación de ambas, por lo que la clasificación de estas lesiones se realiza en relación con la fuente primaria de origen, que puede ser pulpar o periapical, y a partir de estas estructuras afectar al diente en su conjunto, extendiendo el proceso infeccioso, incluso hasta las crestas óseas; no existe marcada diferencia en cuanto a grupos de edades y sexo. Objetivos: el objetivo de este trabajo es presentar el caso clínico de lesión endoperiodontal combinada, secundaria a traumatismo incisal y la importancia de la radiografía para su diagnóstico. Datos del caso: paciente de sexo femenino con antecedentes de salud anterior que acude por presentar dolor y aumento de volumen de color rojo intenso en región de incisivos centrales superiores, radiográficamente aparece una lesión que involucra los tercios apicales de incisivos central y lateral, presentando vitalidad en este último. Fue tratada por el servicio de urgencia realizándosele el acceso cameral. Principales comentarios: Fue necesario realizar en una variedad de exámenes tanto clínicos como pruebas diagnósticas para la diferenciación entre las lesiones endodónticas y periodontales verdaderas. El diagnóstico definitivo solo pudo establecerse sobre la base de los hallazgos clínico-radiográficos. Se realizó un tratamiento combinado endodóntico y periodontal con un buen pronóstico(AU)

Introduction: in dental practice, it is common to find clinical situations in which, in a cursory examination, it is not clear whether this is an endodontic, periodontal or a combination of both affections, so that the classification of these lesions is performed in relation to the primary source of origin which may be pulp or periapical and from these structures affect the tooth as a whole; spreading the infection process, even the bony ridges. There are no marked difference in age groups and sex. Objectives: the aim of this paper is to present a case of combined endoperiodontal injury secondary to incisal trauma and the importance of radiography for diagnosis. Facts of the case: female patient with a history of previous health comes having pain and enlargement of deep red upper central incisor region, radiographically injury involving the apical thirds of central and lateral incisors appear, showing vitality in this one. It was treated by the emergency service by cameral access. Main comments: It was necessary in a variety of both clinical examination and diagnostic tests for differentiating between true endodontic and periodontal lesions. The definitive diagnosis could only be established on the basis of clinical and radiographic findings. Combined periodontal and endodontic treatment was performed with a good prognosis(AU)

Manejo endodóntico de un primer premolar maxilar con tres raíces / Endodontic management of a three-rooted maxillary first premolar

Objetivo: informar el manejo endodóntico de un primer premolar maxilar con tres raíces, mediante tratamiento de conductos adecuado a estos casos. Caso clínico: un paciente de sexo femenino, de 25 años de edad, se presentó a la consulta con un diagnóstico de pulpitis irreversible asintomática en la pieza 14. A partir de los hallazgos clínicos y radiográficos iniciales -que hacían sospechar una alteración en el número de conductos-, se comprobó la presencia de tres conductos radiculares. Esta situación obligó a realizar el tratamiento endodóntico con cuidados específicos para localizar todos los conductos radiculares y prevenir desgastes excesivos y/o perforaciones. Conclusión: el diagnóstico oportuno de esta variación anatómica permite establecer modificaciones en el protocolo del tratamiento de conductos, a fin de evitar el debilitamiento excesivo o, incluso, la perforación de su estrecha anatomía radicular

Estudo dos acupontos estômago 6 e estômago 7 no controle álgico da pulpite irreversível sintomáticaJ / Study of acupoints stomach 6 and stomach 7 on the algic control of symptomatic irreversible pulpits

O termo odontalgia engloba várias doenças dentárias capazes de causar dor, entre elas a pulpite irreversível sintomática (PIS), caracterizada por um pico inflamatório que afeta irreversivelmente as células da polpa dental, gerando uma dor excruciante. Os medicamentos são capazes de gerar analgesia parcial, porém com uma parcela de efeitos colaterais e contraindicações. O tratamento definitivo é realizado preferencialmente através da pulpectomia ou na impossibilidade, através da exodontia. A acupuntura apresenta poucas contraindicações, baixo risco e efetividade analgésica comprovada em diversas condições álgicas. De acordo com os livros texto, vários pontos de acupuntura apresentam efetividade analgésica nas odontalgias, entre elas a PIS. Entretanto, não foram encontrados estudos que suportassem essas conclusões. Assim, o objetivo desse estudo é verificar a existência de tendência de analgesia da acupuntura através de dois pontos de fácil acesso e aplicação: estomago 6 (ST6) e estômago 7 (ST7), em indivíduos portadores exclusivamente de PIS, em apenas um dente. O estudo foi realizado no Serviço de Urgências Odontológicas da FOUSP, seguindo delineamento cross-over em sessão única, randomizado e duplo-cego. Observa-se que os pontos ST6 e ST7 apresentam tendência a reduzir a dor da PIS independentemente de serem utilizados antes ou depois de seu respectivo placebo. Desponta-se assim a necessidade de mais estudos que confirmem essa eficácia, de forma a possibilitar a indicação precisa e o alento para os portadores de uma das odontalgias mais intensas que se tem conhecimento.

The term odontalgia emcompasses several diseases capable to cause pain, including symptomatic irreversible pulpitis (SIP), characterized by an inflammatory peak which irreversibly affects the cells of the dental pulp, causing excruciating pain. The drugs are capable of generating partial analgesia, but with a quota of side effects and contraindications. The definitive treatment is preferably carried out by pulpectomy, or on the inability of it, through the exodonty. Acupuncture has few contraindications, low risk and proven analgesic efficacy in several algic conditions. According to the textbooks, many acupuncture points bring forward analgesic effectiveness in odontalgias, including the SIP. However, no studies that supported these conclusions were found. The aim of this study is to verify the existence of propensity of acupuncture analgesia through two points of easy access and application: stomach 6 (ST6) and stomach 7 (ST7), exclusively in individuals of SIP in just one tooth. The study was conducted in the Department of Emergency Dental FOUSP, following cross-over design in a single session, randomized, double-blind. It is observed that ST6 and ST7 points have a tendency to reduce the pain of SIP whether used before or after the respective placebo. Thus it suggests the need for further studies confirming its effectiveness, in order to enable the precise diagnostic and the breath for patients with one of the most intense odontalgias that are known.

Eficácia da articaína, da lidocaína e da mepivacaína associadas à epinefrina em pacientes com pulpite irreversível em molares mandibulares / Efficacy of articaine, of lidocaine and mepivacaine in patients associated with irreversible pulpitis in mandibular molars

O objetivo deste estudo foi comparar a eficácia anestésica da articaína 4%, da lidocaína 2% e da mepivacaína 2%, todas associadas à epinefrina 1:100.000, durante pulpectomia em pacientes com pulpite irreversível em molares mandibulares. Sessenta e seis voluntários do Setor de Urgência da Faculdade de Odontologia da Universidade de São Paulo receberam, aleatoriamente, 3,6ml de um dos anestésicos locais para o bloqueio convencional do nervo alveolar inferior (NAI). No caso de falha do bloqueio, foram administrados 3,6ml da mesma solução como injeção complementar no ligamento periodontal. O sinal subjetivo de anestesia do lábio, a presença de anestesia pulpar e ausência de dor durante a pulpectomia foram avaliados, respectivamente, por indagação ao paciente, por meio do aparelho estimulador pulpar elétrico (pulp tester) e por uma escala analógica verbal. A análise estatística foi realizada por meio dos testes Qui-quadrado, Kruskal Wallis e Razão de Verossimilhancas. Todos os pacientes reportaram anestesia no lábio após o bloqueio do NAI. A mepivacaína apresentou valores superiores (68,2%) para a anestesia pulpar após o bloqueio do NAI e a lidocaína (90%) após a injeção no ligamento periodontal. A mepivacaína apresentou valores superiores para a analgesia (72,7%) após o bloqueio no NAI e a lidocaína (90%) após a injeção no ligamento periodontal. Após a falha do bloqueio do NAI, a dor na câmara pulpar foi a mais frequente e após a falha da injeção no ligamento periodontal, a dor no canal. No entanto, essas diferenças não foram estatisticamente significantes. Portanto as três soluções anestésicas locais se comportam de forma semelhante e não apresentam efetivo controle da dor no tratamento da pulpite irreversível em molares mandibulares.

The aim of this study was to compare the anesthetic efficacy of 4% articaine, lidocaine 2% and 2% mepivacaine, all associated with epinephrine 1:100,000 during pulpectomy in patients with irreversible pulpitis in mandibular molars. Sixty-six volunteers Sector Emergency Faculty of Dentistry, Universidade de São Paulo randomly received 3.6 ml of a local anesthetic to block conventional inferior alveolar nerve. In case of failure of the lock, were administered 3.6 ml of the same solution as in the periodontal ligament injection complement. The signal subjective lip anesthesia, the presence of pulpal anesthesia and no pain during pulpectomy were evaluated respectively by questioning the patient, via the stimulating device electrical pulp (pulp tester) and a verbal analogue scale. Statistical analysis was performed using the chi-square test, Kruskal Wallis and likelihood ratio. All patients reported lip anesthesia after blockade of the inferior alveolar nerve. The mepivacaine showed higher values (68.2%) for pulpal anesthesia after blockade of the inferior alveolar nerve and lidocaine (90%) after injection in the periodontal ligament. The mepivacaine showed higher values for analgesia (72.7%) after blocking the inferior alveolar nerve and lidocaine (90%) after injection in the periodontal ligament. After the failure of the blockade of the inferior alveolar nerve, the pain in the pulp chamber was the most frequent and after the failure of the periodontal ligament injection, pain in the channel. However, these differences were not statistically significant. Therefore, the three local anesthetic solutions behave similarly and did not exhibit effective pain management in treating irreversible pulpitis in mandibular molars.

Importancia de la semiología del dolor en el diagnóstico de un proceso inflamatorio pulpar / Significance of pain's Symptomatology in the diagnosis of pulpal inflammatory process

El dolor es un síntoma de extraordinaria importancia en la práctica estomatológica y particularmente en lo concerniente a las alteraciones de la pulpa dentaria. Con el objetivo de profundizar en el conocimiento de las fases por las que atraviesa un proceso inflamatorio pulpar, que permiten predecir sus manifestaciones dolorosas, se realizó una revisión bibliográfica sobre el tema con un enfoque multidisciplinario y básico-clínico. Se utilizó el método documental para el análisis y tratamiento de la información ofrecida por las fuentes teóricas. El sitio en Internet Google fue empleado como fundamental motor de búsqueda y Lilacs, Hinari, Medline y PubMed fueron las bases de datos más revisadas. La clasificación del estado de inflamación pulpar, que atiende a eventos histopatológicos que no se pueden visualizar, resulta más difícil. Se podría lograr mayor precisión en un diagnóstico basado en el curso que sigue el dolor, de acuerdo a la magnitud del compromiso inflamatorio y apoyado en la rica semiología que se puede obtener si se sigue la trayectoria de las variables del estímulo nociceptivo. El incremento y profundización de los conocimientos en este campo contribuiyó significativamente a un mejor diagnóstico y tratamiento de los procesos inflamatorios pulpares(AU)

Pain is a symptom very important in the stomatologic practice and particularly in that concerning to dental pulp alterations. To deep in the knowledge of phases crossed by a pulpal inflammatory process allowing predicting its painful manifestations, authors made a bibliographic review on this subject with a multidisciplinary and basic-clinical approach, using the documentary method for analysis and management of information offered by theoretical sources. Google was used as a fundamental search tool and LILACS, HINARI, Medline and PubMed were the more reviewed databases. The classification of pulpal inflammation state, taking into account non-visualized histopathology events is more difficult and it may to achieve a great accuracy in a diagnosis based on course after pain, according the magnitude of inflammatory compromise and supported by the potential valuable symptomatology if we follow the trajectory of the nociceptive stimulus variables. The know ledges increase and deepening in this field will contribute in a significant way to a better diagnosis and treatment of pulpal inflammatory processes(AU)

Eficacia del láser en el tratamiento de la pulpitis aguda serosa / Effectiveness of laser in the treatment of serous acute pulpitis

Se desconoce que la sintomatología álgica de la pulpitis aguda serosa es la principal razón por la que acuden nuestros pacientes a consulta de urgencias, así como las posibilidades terapéuticas del láser en el tratamiento de la misma. Objetivo: evaluar la eficacia de la terapia láser en el tratamiento de la pulpitis aguda serosa. Método: se realizó un ensayo clínico fase II temprana, abierto y uní céntrico, el cual fue ejecutado en la consulta de láser terapia de la Clínica Estomatológica Provincial Docente Ismael Clark y Mascar, desde enero de 2006 a octubre de 2007. El tratamiento tuvo un carácter ambulatorio, se aplicó láser con el equipo LASERMED 670DL de fabricación cubana con parámetros antiinflamatorios y analgésicos, con una frecuencia diaria hasta las 72h, a aquellos pacientes a los cuales les fue diagnosticado pulpitis aguda serosa y que estuvieron de acuerdo a participar en el estudio. La intensidad del dolor se evaluó en cada consulta de evolución, a través de una escala descriptiva simple, todo lo cual permitió evaluar la eficacia del tratamiento aplicado. Resultados: el estudio realizado arrojó resultados altamente significativos, ya que el 95 por ciento de los casos en estudio remitieron la sintomatología dolorosa, a partir de las 48h. El grado de satisfacción de los pacientes ante la terapéutica empleada y la condición de satisfactoria, estuvo en relación directa con los resultados obtenidos. Conclusiones: el láser resultó eficaz para el tratamiento de la pulpitis aguda serosa al lograr un alivio del dolor en un período de tiempo corto y no producir efectos colaterales significativos.

Therapeutic possibilities of laser are unknown in the treatment of serous acute pulpitis and it is a disease where the algesic symptomatology, constitutes the main reason for which our patients assist to the urgency consultation. Objective: to determine the effectiveness of the laser therapy in the treatment of serous acute pulpitis. Method: an early stage II, open and unicentric clinical trial was conducted, which was carried out in the laser therapy consultation at the Teaching Provincial Odontology Clinic Ismael Clark y Mascaró, from January 2006 to October 2007. The treatment had an ambulatory character, laser was applied with LASERMED 670DL equipment of Cuban manufacturing with anti-inflammatory and analgesic parameters, to patients that were diagnosed serous acute pulpitis, and also were in agreement to take part in the study, with a daily frequency up to 72h. The intensity of pain was evaluated in each evolution consultation, through a simple descriptive scale, which allowed evaluating the efficacy of the treatment applied. Results: the study showed highly significant results since the 95 percent of cases under study remitted the painful symptomatology, starting from 48h. The grade of patients' satisfaction before the therapy used and the condition of satisfactory was in direct relationship with the obtained results. Conclusions: laser turned out to be effective for the treatment of serous acute pulpitis on achieving a pain relief in a short period of time and do not produce significant collateral effects.

Diagnostic and clinical factors associated with pulpal and periapical pain

A retrospective survey was designed to identify diagnostic subgroups and clinical factors associated with odontogenic pain and discomfort in dental urgency patients. A consecutive sample of 1,765 patients seeking treatment for dental pain at the Urgency Service of the Dental School of the Federal University of Goiás, Brazil, was selected. Inclusion criteria were pulpal or periapical pain that occurred before dental treatment (minimum 6 months after the last dental appointment), and the exclusion criteria were teeth with odontogenic developmental anomalies and missing information or incomplete records. Clinical and radiographic examinations were performed to assess clinical presentation of pain complaints including origin, duration, frequency and location of pain, palpation, percussion and vitality tests, radiographic features, endodontic diagnosis and characteristics of teeth. Chi-square test and multiple logistic regression were used to analyze association between pulpal and periapical pain and independent variables. The most frequent endodontic diagnosis of pulpal pain were symptomatic pulpitis (28.3 percent) and hyperreactive pulpalgia (14.4 percent), and the most frequent periapical pain was symptomatic apical periodontitis of infectious origin (26.4 percent). Regression analysis revealed that closed pulp chamber and caries were highly associated with pulpal pain and, conversely, open pulp chamber was associated with periapical pain (p<0.001). Endodontic diagnosis and local factors associated with pulpal and periapical pain suggest that the important clinical factor of pulpal pain was closed pulp chamber and caries, and of periapical pain was open pulp chamber.

Um estudo retrospectivo foi realizado para identificar fatores clínicos e de diagnóstico associado com a dor de origem odontogênica. Foram selecionados 1765 pacientes que buscaram tratamento para dor odontogênica no Serviço de Urgência da Faculdade de Odontologia da Universidade Federal de Goiás. Os critérios de inclusão foram dor de origem pulpar ou periapical antes do tratamento dentário (mínimo de 6 meses depois da última consulta odontológica), e os critérios de exclusão foram dentes com anomalias de desenvolvimento e falta de informações ou registros incompletos. Avaliações clínicas e radiográficas foram realizadas para se obter as características clínicas de dor, incluindo origem, duração, frequência e localização da dor, testes de palpação, percussão e vitalidade pulpar, aspectos radiográficos, diagnóstico endodôntico e características dos dentes. Os testes qui-quadrado e regressão logística múltipla foram utilizados para verificar a associação entre a dor de origem pulpar e periapical e variáveis independentes. O diagnóstico endodôntico de dor de origem pulpar mais frequente foi pulpite sintomática (28,3 por cento) seguido por pulpalgia hiper-reativa (14,4 por cento), e o mais frequente de dor de origem periapical foi periodontite apical sintomática infecciosa (26,4 por cento). Análise de regressão revelou que câmaras pulpares fechadas e cáries estavam altamente associadas à dor pulpar e, inversamente, câmara pulpar aberta estava associada à dor periapical (p<0,001). O diagnóstico endodôntico e fatores locais associados com dor de origem pulpar e periapical sugerem que os fatores clínicos importantes das dores pulpares foram câmaras pulpares fechadas e cáries, e de dor periapical foi câmara pulpar aberta.

Semiología de la pulpa: signos, síntomas y determinación del estado pulpar / Semiology of the pulp: signs, symptoms and pulp status determination

Es sabido que para toda intervención en medicina u odontología es imperativo proceder a realizar un correcto diagnóstico de la patología a tratgar; la operatoria dental no escapa a esta regla, debiendo el profesional realizar el diagnóstico de la lesión de los tejidos duros del diente pero además de su estado pulpar; y es precisamente aquí donde debe agudizar sus sentidos para observar la presencia de alguna patología y determinar en primera instancia el área de su incumbencia, o la derivación a la endodoncia. Es en este punto donde se cometen infinidad de errores ya que existe una sutil línea a partir de la cual la lesión pulpar pasa a un estadio irreversible. Es muy común intentar determinar el estado pulpar por la extensión de la lesión sin reparar en que existen grandes cavidades con tejido pulpar sano y pequeñas lesiones con patologías irreversibles. También es habitual que el profesional se guíe para la toma de decisiones por una radiografía, sin comprender que la misma no determina el estado pulpar. Por todo esto, es necesario conocer diferentes pruebas o tests que nos ayudan a diagnosticar con el menor margen de error posible, para encarar así un adecuado tratamiento.

Dental pain - A case of missed diagnosis

Dental pain, without doubt is one of the worst pains experienced by humans. The purpose of this article is to discuss investigations, diagnosis and management of acute dental pain with reference to case report of a patient. The patient suffered from acute pulpitis due to an apparently minor dental problem. Due to peculiar anatomy and innervation of dental pulp it is difficult for the patient and the dentist to identify the offended tooth in the initial stage of pulpitis. Different causes of dental pain are discussed. Classification and characteristics of dental pulp sensory fibers are also described briefly

Estudo epidemiológico de urgências odontológicas / Epidemiologic study of urgencies in dentistry

O objetivo deste estudo retrospectivo foi determinar a razão da procura de atendimento de urgência na Faculdade de Odontologia da Universidade de Pernambuco, no segundo semestre de 2000, e relacionar o diagnóstico dos casos com o tratamento proposto, gênero e idade dos pacientes. Foram utilizados 227 prontuários de pacientes de ambos os gêneros, com idade variando de 11 a 81 anos. De posse dos dados, foram realizados as estatísticas descritivas e inferencial. A amostra consistiu de 70,5% de pacientes do gênero feminino e 29,5% do masculino. A idade média foi de 29 anos (DP = 11,75 anos). Dos casos atendidos, 33% tiveram como diagnóstico pulpite irreversível sintomática, seguida de 17,2% de pulpite reversível. A abertura coronária doi indicada nos casos de pulpite irreversível sintomática, abcesso dentoalveolar agudo e periodontite apical aguda, correspondendo a 55,1% dos tratamentos realizados. Conclui-se que o alto percentual de urgências endodônticas reflete o perfil de saúde bucal da população atendida, exibindo um alto padrão cariogênico que necessita ser revertido

Clinical study of patients with persistent orofacial pain

OBJETIVO: Avaliar uma amostra de doentes com dor facial persistente. MÉTODO: Foram revisados 26 prontuários de doentes com dor facial persistente (20 mulheres e 6 homens). RESULTADOS: Classificação dos doentes, após o diagnóstico: a)Grupo I, oito pacientes (30,7%) com dor facial difusa de fortíssima intensidade; b)Grupo II, oito pacientes (30,7%) com dor crônica de natureza não-miofascial e; c)Grupo III, dez pacientes com dor crônica miofascial (38,4%). Foram encontrados 11 diagnósticos diferentes entre os 26 pacientes: pulpites(7), leucemia(1), tumor de orofaringe(1), odontalgia atípica(1), síndrome de Eagle(1), neuralgia idiopática do trigêmeo(4), neuralgia atípica(1), disordens temporomandibular (9), fibromialgia(2) cefaléia tipo-tensão(1), histeria de conversão(2). O acompanhamento dos doentes, após receberem a respectiva terapia, foi de seis meses, com alívio da dor, exceto para o doente com tumor de orofaringe. CONCLUSAO: A variabilidade das fontes da dor facial inclui doenças benignas e doenças graves, sendo indispensável a reavaliaçâo de doentes que não respondem aos tratamentos convencionais para a dor.