Correlation between Dental Pulps Pain and Hormonal Changes during Pregnancy- A Clinical Investigation

The hormonal and physiological changes that come with pregnancy are unique. The aim of this clinical investigation was to observe a correlation between dental pulpal pain and hormonal changes during pregnancy. Methods: Out of hundred pregnant females examined seventy four females were having tooth or teeth indicative of either pulpal therapy or root canal treatment (RCT). On explaining their dental status forty pregnant females with no pain or mild pain agreed to take dental treatment, they were grouped as Group A and the remaining thirty-four who were reluctant and refused dental treatment were classified in Group B. Results: In Group A, thirty-five pregnant got their dental treatment completed along with regular Obstetrics & Gynecological (Obs&Gyne) follow up. In Group B, twenty- four pregnant females were on regular Obstetric & Gynecological follow up and ten of them even did not turned up for either. In Group B twentytwo pregnant females turned back to seek dental treatment due to pain, inflammation or inability to chew food during third trimester which were pain free earlier. In Group A, three out of five also came back for dental treatment. All the data collected was subjected to statistical analysis using paired-t test and Pearson r correlation test. Conclusion: Significant difference was observed with reduced pain threshold during third trimester and +1 coefficient was found stating a significant relationship between dental pulpal pain and raised levels of estrogen and progesterone during pregnancy.

Descripción de las propiedades funcionales del sistema nociceptivo trigeminal en relación con el dolor pulpar / Description of the functional properties of the nociceptive trigeminal system in relation to pulpal pain

El sistema trigeminal nociceptivo es un componente del sistema sensorial somestésico que tiene la capacidad de discriminar cuatro variables básicas de los estímulos que provocan daño tisular, ellas son: cualidad, curso temporal, localización e intensidad. Las fibras A delta y C, vinculadas a la nocicepción están presentes en la pulpa dental. Se utilizan varias clasificaciones del dolor, atendiendo a diversos criterios: calidad de la sensación, velocidad de transmisión por las fibras, en relación con el lugar del cuerpo donde se exprese, y a la ubicación del nociceptor. La evolución de las condiciones pulpares se clasifican como: pulpitis reversible, pulpitis transicional, pulpitis irreversible y pulpa necrótica.Según su cualidad, el dolor pulpar puede ser punzante o continuo; atendiendo a su aparición, provocado o espontáneo; por su curso, intermitente o continuo; por su localización puede ser limitado a una región, irradiado y referido; y en relación con su intensidad se considera leve, moderado o severo. La capacidad del sistema sensorial nociceptivo en cuanto a discriminar la modalidad, curso temporal, localización e intensidad del estímulo, permite conocer las diferentes etapas de un proceso inflamatorio pulpar(AU)

The nociceptive trigeminal system is a component of the somatosensory system capable of distinguishing four basic variables of stimuli causing tissue damage: quality, time course, location and intensity. A-delta and C fibers, which are related to nociception, are present in dental pulp. Several classifications of pain are used, based on various criteria: quality of the sensation, transmission velocity along fibers, body part where it is expressed, and location of the nociceptor. According to their evolution, pulpal conditions are classified into reversible pulpitis, transitional pulpitis, irreversible pulpitis and necrotic pulp. Pulpal pain has been classified according to the following variables: quality: sharp or continuous; cause: provoked or spontaneous; course: intermittent or continuous; location: limited to a region, radiating or referred; and intensity: mild, moderate or severe. The capacity of the nociceptive sensory system to distinguish the mode, time course, location and intensity of the stimulus makes it possible to recognize the different stages of a pulpal inflammatory process(AU)

An Insight Into Neurophysiology of Pulpal Pain: Facts and Hypotheses

Pain and pain control are important to the dental profession because the general perception of the public is that dental treatment and pain go hand in hand. Successful dental treatment requires that the source of pain be detected. If the origin of pain is not found, inappropriate dental care and, ultimately, extraction may result. Pain experienced before, during, or after endodontic therapy is a serious concern to both patients and endodontists, and the variability of discomfort presents a challenge in terms of diagnostic methods, endodontic therapy, and endodontic knowledge. This review will help clinicians understand the basic neurophysiology of pulpal pain and other painful conditions of the dental pulp that are not well understood.

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.