Does Virtual Reality Affect Children's Dental Anxiety, Pain, And Behaviour? A Randomised, Placebo-Controlled, Cross-Over Trial

ABSTRACT Objective: To evaluate the effect of virtual reality (VR) on dental anxiety, pain, and behaviour at different time points among children undergoing dental treatment under local anaesthesia. Material and Methods: This randomised, two‐armed, within-subject, cross-over, placebo-controlled trial included 76 children. Eligible participants were treated in two dental visits using the following methods: with protective glasses only, without distraction (attention placebo-controlled - APC); and with the treatment condition (i.e., VR). Primary outcomes were dental anxiety and pain; secondary outcome was dental visit behaviour. Heart rate scores were recorded as an objective measure to evaluate dental anxiety and pain. Subjective measurements for each variable were also performed. Results: Significant reduction in dental pain and anxiety was observed in the VR group, according to the heart rate scores; however, no statistical differences were observed according to the self-reported measures. Decreased dental anxiety and pain were associated with the first visit sequence with VR. Dental pain and anxiety scores were lower during local anaesthesia in the VR group than in the APC group. Conclusion: Virtual reality significantly reduced pain and anxiety during local anaesthesia in children undergoing dental treatment; therefore, it may be recommended during dental treatment in school-age children.

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.

Factors Associated with Toothache in Patients Affected by Hereditary Coagulopathies

Objective: To determine a probabilistic model that represents the likelihood of the event Dental Pain to occur in Brazilians patients affected by hereditary coagulopathies. Material and Methods: In this cross-sectional study, information on use and access to dental services, oral morbidity, self-perceived oral health and behavioral health habits were obtained through semi-structured questionnaire and analyzed by means of logistic regression. Results: High prevalence of dental caries was observed for children aged 1-5 years (50%) and for adolescents aged 13-19 years (66%). Cumulative pattern of dental caries in the age groups of 20-35 years and 36-59 years was observed. Most patients did not report pain in the last six months prior to the survey (24.5%). It was observed that searching for dental care for the last time in case of localized pain (OR=26.7), for feeling uncomfortable when brushing teeth (OR=7.3) and difficulty searching for health professionals, not only the dentist (OR 3.7) was considered risk factors for the determination of Dental Pain diagnosis. However, if the patient has mild hemophilia A (OR=0.21), this likelihood decreases, being thus a protective factor. Conclusion: Patients affected by hereditary coagulopathies have high prevalence of caries, indicating the cumulative nature of this disease, which suggests the symptomatic effect of Dental Pain.

Socioeconomic level and the parents' perception of the impact of oral diseases on their children's quality of life

Aim: To analyze how parents of different socioeconomic levels perceive the impact of oral diseases on their children's quality of life. Methods: All parents or guardians of students aged 11 to 14 years old, regularly enrolled in fundamental schooling at public schools of two towns in the northwestern region of the State of São Paulo, Brazil, were enrolled in the study. The questionnaire of "Socioeconomic Assessment Tool" was used to classify the families with regards to socioeconomic class and the "Parental-Caregiver Perceptions Questionnaire (P-CPQ)" was used to verify the parents' perception of the impact of oral diseases on their children's quality of life. Results: 172 (41.8%) individuals answered the survey. Among them, most belonged to the Upper Low Class (61%). 21.5% of the individuals answered that they considered their children's oral health "regular or bad" and 71.5% answered that their child's general well-being was not or was little affected by the condition of his/her teeth, lips, jaws or mouth. There was an association between the quality of life sub-scales, especially "oral symptoms", with all socioeconomic classes. Conclusions: There is a relationship between parents' socioeconomic class and the perception of the impact of oral disease on their children's quality of life (Au)

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.

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.

Equivalência de instrumentos de qualidade de vida em saúde bucal com a Classificação Internacional de Funcionalidade, Incapacidade e Saúde / Equivalence of instruments of quality of life in oral health with the International Classification of Functioning, Disability and Health

A Organização Mundial de Saúde (OMS) definiu a qualidade de vida como a percepção do indivíduo sobre si, no contexto de valores em que vive e em relação a: metas, expectativas, parâmetros e relações sociais. O objetivo do estudo foi realizar a equivalência dos instrumentos de qualidade de vida (University of Washington - Quality of life (UW-QOL), Brief Core Set Questionnaire - Head and Neck - BCSQ H&N), em pacientes com câncer de boca, diagnosticados na Liga de Neoplasia Bucal (LINB) e o Oral Health Impact Profile (OHIP-14) para pacientes que buscaram por atendimento de urgência, com a Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). Foram entrevistados 50 pacientes atendidos pela Liga de Neoplasias da FOUSP e 100 pacientes do Setor de Urgências da Clínica Odontológica da FOUSP. Os escores de cada instrumento foram pontuados e, em seguida, verificou-se a frequência de ocorrência dos domínios. As categorias mais frequentes nos instrumentos de qualidade de vida UW-QOL, foram: b152 (Ansiedade - Funções Emocionais), b510 (Funções de ingestão - saliva), b250 (Função gustativa). No questionário BCSQ H&N, as categorias mais frequentes foram: b510 (Funções de ingestão), b310 (Funções da voz) e b152 (Funções emocionais). No questionário OHIP-14, as categorias mais pontuadas foram: b280 (Sensação de dor), b152 (Funções emocionais) e b130 (Funções da energia e dos impulsos - Atividade). Foi observada equivalência entre os domínios dos instrumentos de qualidade de vida e a CIF. Assim, a CIF constitui instrumento útil para avaliar a real situação de saúde do paciente, além dos aspectos clínicos.

The World Health Organization (WHO) defined quality of life as the perception of the individual in his life, in the context of values in which they live and in relation to their goals, expectations, parameters and social relations. The objective of the study was to perform the equivalence of quality of life instruments, University of Washington - Quality of Life (UW-QOL), Brief Core Set Questionnaire - Head and Neck (BCSQ H&N) in patients with diagnosed oral cancer in the League of Oral Neoplasms (LINB); and the Oral Health Impact Profile (OHIP-14) for patients who sought for emergency care, with the International Classification of Functioning, Disability and Health (ICF). Fifty patients from the Oral Neoplasms League and 100 patients from the Urgency Clinic at FOUSP were interviewed. Each instrument's scores were registered and the occurrence frequency of each domain was verified. The most frequent categories of instruments in quality of life UW-QOL were: b152 (Anxiety - Emotional functions), b510 (Ingestion functions - saliva), b250 (Taste function). At BCSQ H&N the most frequent categories were: b510 (Ingestion functions), b310 (Voice functions) and b152 (Emotional functions). In the OHIP-14 questionnaire, the highest scoring categories were: b280 (Sensation of pain), b152 (Emotional functions) and b130 (Energy and drive functions - Activity). Equivalences was observed among the instruments´ domains and ICF. Thus, ICF is a useful tool to perform real evaluations on the patients´ health, adding information to the clinical aspects.

Fatores determinantes da dor de dente e o impacto na vida diária de indivíduos residentes em Betim-MG/2013 / Determinants of toothache and impact on daily living among residents of betim, Brazil

O objetivo do presente estudo foi avaliar a prevalência e o impacto da dor de dente e seus fatores determinantes, em adultos de 35 a 44 anos de idade residentes no sudeste do Brasil, município de Betim-MG. O primeiro e o segundo estudo consistiram em estudos transversais com objetivo de investigar a dor de dente e seu impacto na vida diária e na qualidade de vida. Um questionário foi aplicado em uma amostra de 744 indivíduos a avaliação da cárie dentária realizada através do índice CPO-d. A dor de dente relatada nos últimos 6 meses foi o desfecho estudado. No primeiro estudo as variáveis referentes à dor de dente foram agrupadas em três dimensões: acesso aos serviços de saúde bucal, gravidade da dor de dente e limitação social/funcional. Observou-se que 68% apresentaram baixo acesso, 39,7% alta gravidade e 47,3% alto impacto da dor de dente na vida diária. Dos impactos investigados o nervosismo (87,2%) e a dificuldade para mastigar (72,6%) foram os mais freqüentes. Através da análise por correspondência foram identificados quatro grupos com perfis distintos para dor de dente e seus fatores associados. Dois grupos apresentaram maiores efeitos da dor de dente na vida diária. Um composto por indivíduos que tiveram um menor acesso aos serviços de saúde bucal (mulheres, pardas, casadas, 1º grau, baixa renda familiar)...

Fatores associados à automedicação em um serviço brasileiro de emergência odontológica / Factors associated with self-medication in a brazilian emergency dental service

Objetivo: investigar os fatores associados à automedicação por pacientes atendidos em um serviço de emergências odontológicas em Belo Horizonte, MG, Brasil. Métodos: foi aplicado um questionário entre 174 pacientes atendidos na emergência odontológica contendo informações referentes ao gênero, idade e questões específicas como consumo anterior de medicamentos, ervas medicinais ou outras substâncias para o alívio da sintomatologia dolorosa. O diagnóstico clínico foi definido por somente um dentista. Análise bivariada e regressão multivariada de Poisson com variância robusta foram realizadas no programa SPSS 18.0. O estudo foi aprovado pelo Comitê de Ética de Pesquisa em Humanos. Resultados: a média de idade foi de 32,6 (+12,0) anos e 51,8% eram mulheres. Entre os participantes do estudo, 81,7% relataram terem se automedicado. A idade (p=0,83), a duração da dor (p=0,21) e o gênero (p=0,85) não estiveram associados à variável resposta. A frequência da automedicação foi mais alta (p-0,04) entre indivíduos com pulpites agudas (86,8%) e abscessos periapicais (84,7%). Somente o diagnóstico clínico esteve associado à automedicação na análise multivariada de Poisson. Comparando a outros diagnósticos, indivíduos com pulpites relatam 2,3 mais chances de se automedicarem (IC95% 1.1-5.0; p=0.03). Conclusão: a automedicação é um problema de saúde pública preocupante entre o grupo estudado. O diagnóstico clínico é o único fator que influencia este fenômeno dentre a população estudada.

Objective: To investigate factors associated with self-medication by patients treated at a public emergency dental service in Belo Horizonte, MG, Brazil. Method: A questionnaire was applied to174 patients who have been treated in the emergency dental service, with information about gender, age and specific questions about previous consumption of medicines, medicinal herbs or other substances to relieve dental pain. Clinical diagnosis was established by a single dentist. Bivariate analysis and multivariate Poisson regression with robust variance were carried out in SPSS 18.0 software for Windows. The study was approved by the local Human Research Ethics Committee. Results: The mean age of the patients was 32.6 (±12.0) years and 51.8% were female. Among the participants in the survey, 81.7% reported self-medication. Age (p=0.83), duration of pain (p=0.21) and gender (p=0.85) were not associated. Frequency of self-medication was higher (p=0.04) among individuals with pulpitis (86.8%) and periapical abscess (84.7%). Only clinical diagnosis was associated with self-medication in the multivariate Poisson analysis. Patients with pulpitis reported 2.3 times more self-medication (IC95% 1.1-5.0; p=0.03) than individuals with other diagnoses. Conclusion: Self-medication was an important health problem in the studied this surveyed group. Clinical diagnosis was the only factor that influenced this phenomenon.

Barodontalgia em voo e diagnóstico diferencial de dor odontogênica / In flight barodontalgia and differential diagnosis of odontogenic pain

Os pilotos são responsáveis pelas vidas da tripulação e passageiros, pela conclusão do voo em segurança. Por este motivo, a saúde e bem estar destes profissionais é de extrema importância. Uma condição que pode aparecer em vôo é a Barodontalgia, que é uma dor aguda causada pela diferença de pressão atmosférica no dente. Tal ocorrência pode levar a vertigem, incapacitação do profissional, e finalização prematura do vôo. Objetivo do trabalho foi realizar uma revisão de literatura sobre barodontalgia evidenciando a etiologia, condições de aparecimento, bem como conduta para o manejo dos aeronavegantes. A literatura considera que as causas descritas são: cárie profunda, restauração desadaptada, tratamento endodôntico incompleto, abscesso periodontal/periapical, e extrações recentes. Doenças congestivas dos seios paranasais, sobretudo do seio maxilar, podem se assemelhar a barodontalgia. As tripulações de aeronaves civis e militares têm maior potencial para experimentar tal ocorrência, por conta disso, sua saúde bucal deve ser periodicamente avaliada, e ainda os cirurgiões-dentistas devem estar conscientes da possibilidade da ocorrência deste fenômeno durante a jornada de trabalho destes profissionais, bem como estar preparados para o uso de medidas preventivas e curativas, a fim de reduzir sua incidência e gravidade, melhorando as condições de trabalho desta população

Pilots are responsible for the lives of the crew and passengers, and for completing the flight safely. For this reason, health and welfare of these professionals is extremely important. A condition that may appear in flight is Barodontalgia, which is a sharp pain caused by the difference in air pressure in the tooth. Such an occurrence can lead to dizziness, professional disability, and premature termination of the flight. The purpose of the study was a literature review on the etiology of barodontalgia, conditions of appearance, and the management of air crew. The literature describes as causes: deep decay, defectives restoration, incomplete root canal therapy, periodontal abscess/ periapical, and recent extractions. Congestive diseases of the paranasal sinuses, especially of the maxillary sinus may resemble barodontalgia. The crews of civil and military aircraft have greater potential to experience such an occurrence, because of that, their dental health should be periodically evaluated, and even the dentists should be aware of the possibility of this phenomenon during the working hours of these professionals, and be prepared for the use of preventive and curative measures, in order to reduce its incidence and severity, improving working conditions in this population

Urgencias estomatológicas en niños institucionalizados de La Habana / Stomatology urgencies in institutionalized children in Havana

Se realizó un estudio observacional, descriptivo y transversal para caracterizar el comportamiento de las urgencias estomatológicas en los niños de los círculos infantiles del área de salud del Policlínico Universitario 27 de Noviembre del municipio Marianao, La Habana. El universo estuvo constituido por 450 niños de ambos sexos, matriculados en los tres círculos infantiles del área de salud, durante el curso escolar 2006-2007. La muestra estuvo representada por 175 niños con diagnóstico de lesiones por caries dental y sus secuelas, en los cuales se tuvo en cuenta edad, sexo, frecuencia de asistencia a la consulta de urgencias y severidad de la caries. La frecuencia de asistencia a consulta de urgencia siguió un patrón de más de una vez en todas las edades excepto el grupo de 4 años, en el que la mayoría asistió solamente una vez. El 22,2 por ciento de los niños de 5 años necesitaron el servicio de urgencia en dos ocasiones. El dolor fue la causa más frecuente de asistencia a la consulta de urgencia, y se manifestó, solamente en las edades de 4 y 5 años, con predominio de severidad grado 1, y de ellos el sexo masculino estuvo más afectado. La asistencia a consulta de urgencias aumentó con la edad, con predominio del sexo masculino, quienes acudieron más de una vez por la presencia de dolor, a pesar de predominar caries de severidad grado 1(AU)

A cross-sectional, descriptive and observational study was conducted to characterize the behavior of Stomatology urgencies in children of Nurseries from 27 de Noviembre polyclinic health area of Marianao municipality in La Habana, Cuba. Universe included 450 boys and girls, registered in the three nurseries of health area diagnosed with dental caries analyzing age, sex, frequency of urgency consultation assistance and caries's severity. In parents a questionnaire was administered. From the 175 boys and girls affected of dental caries, there were 56 with a four years involvement due to caries being the more frequent to urgency consultation for a 10,9 percent and the highest frequency was twice, in boys and girls aged 5 for a 5,7 percent. A total of 17 children visited more frequent the urgency consultation with two visits for a 9,7 percent. Boys and girls aged 5 were more frequent to above mentioned consultation due to pain followed by those aged 4. There was predominance of I degree severity for a 68,1 percent and in these suffered of pain for a 27,6 percent. There is an increasing assistance to urgency consultation increase according to age with predominance of male sex, requiring this type of serve often due to pain despite predominance of 1 degree severity of caries(AU)

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.

Endo-perio lesions: Diagnosis and clinical considerations.

The interrelationship between periodontal and endodontic disease has aroused confusion, queries and controversy. Differentiating between periodontal and endodontic problems can be difficult. A symptomatic tooth may have pain of periodontal and/or pulpal origin. The nature of that pain is often the first clue in determining the etiology of such a problem. Radiographic and clinical evaluation can help clarify the nature of the problem. In some cases, the influence of pulpal pathology may create periodontal involvement. In others, periodontal pathology may create pulpal pathology. This review article discusses the various clinical aspects to be considered for accurately diagnosing and treating endo-perio lesions.

Plantas empleadas en odontalgias I / Plants used for toothache

En la consulta estomatológica, las odontalgias son padecimientos frecuentes, los cuales por su magnitud disminuyen la capacidad y rendimiento del individuo. Para tratar dichas alteraciones se emplean fármacos de diversa naturaleza, aunque desde tiempos remotos diversas plantas también han sido empleadas. Nuestra flora medicinal es una de las más diversas del mundo y por supuesto incluye algunas utilizadas con la misma finalidad. En este estudio, se presentan 51 especies que corresponden a 29 familias botánicas reportadas como utilizadas en odontalgias en diferentes países, principalmente en México y que son usadas por la medicina tradicional. Dichas plantas elaboran, entre otros, metabolitos secundarios con posible actividad biológica: aceites esenciales, alcaloides, cardenólidos, ciclitoles, glucósidos-iridoides, heterósidos cianogenéticos, mucílagos, resinas, saponinas, sesquiterpenos, taninos y triterpenos. Las partes de los vegetales empleadas son muy variadas e incluyen en algunos casos a la planta entera fresca. Las formas de uso más frecuentemente reportadas fueron las infusiones y los cocimientos. La vía de administración es local, tópica o por medio de enjuagues, o bien ingiriendo la infusión o el cocimiento, aunque algunas plantas se aplican en forma de cataplasma.

Odontalgia is a very common disorder, frequently observed in patients visiting the dentist office. Due to its severity, odontalgia may significantly reduce the performance capability of the subject. At present, many drugs from different origins are being used for the odontalgia treatment. However, from ancient times, several plants have also been used. As our medicinal flora has one of the greatest diversity in the world, it certainly includes some plants that can be employed for such purpose. This study includes 51 species, belonging to 20 botanical families, which have been reported as useful for odontalgia treatment by traditional medicine in several countries, mainly in Mexico. Such plants produce several secondary metabolites with probable biologic activity, among them: essential oils, alkaloids, cardenolides, ciclitols, glycoside-iridoids, heterosides, cyanogenics, mucilages, resins, saponines, sesquiterpenes tannins and triterpenes. The parts of the plant that might be used for the odontalgia control are diverse; sometimes even the whole fresh plant can be used. The most frequently reported methods of preparation are infusion and concoction. The administration is mainly local (topic) or as mouthwash, or by drinking the infusion or decoction. Some of the plants can be prepared and applied as poultice.

Odontalgia atípica: revisão de literatura / Atypical odontalgia: review of literature

A Odontalgia Atípica (OA) é uma entidade clínica importante, pois a dor é neuropática por desaferentação e ocorre “no dente”, porém não é “dor de dente”. É caracterizada por dor em um dente ou dor em um sítio onde um dente foi extraído, com ausência de sinais clínicos ou radiográficos que acusem uma doença. Muitas vezes por insistência dos pacientes o tratamento endodôntico é realizado, mas não ocorre alívio da dor. Assim, tratamentos invasivos continuam sendo realizados incluindo retratamento endodôntico, apicetomia e finalmente a extração do dente. Sendo uma enfermidade que pode trazer alguma dificuldade diagnóstica para o cirurgião-dentista, o conhecimento de suas características se torna necessário. Deste modo, este artigo apresenta uma revisão de literatura sobre esta entidade, onde são abordados os seguintes tópicos: epidemiologia e sinais clínicos, critérios de diagnóstico, etiologia, diagnóstico diferencial e abordagens terapêuticas.

The Atypical Odontalgia (AO) it is an important clinical entity, because the pain is neuropatic for deafferentation and it happens “in the tooth”, however it is not “toothache.” It is characterized by pain in a tooth or pain in a ranch where a tooth was extracted, with absence of clinical signs or radiographics that accuse a disease. A lot of times for the patients’ insistence the endodontic treatment is accomplished, but it doesn’t happen relief of the pain. Like this, invasives treatments continue being accomplished including endodontic retreatment, apicectomy and finally the extraction of the tooth. Being an illness that can bring some diagnostic difficulty for the surgeon-dentist, the knowledge of their characteristics becomes necessary. This way, this article presents a literature revision on this entity, where the following topics are approached: epidemiology and clinical signs, diagnosis criteria, aetiology, differential diagnosis and therapeutic approaches.

Determining toothache severity in pediatric patients: A study.

To correlate sodium-potassium levels in saliva of pediatric patients having different intensities of toothache assessed by Visual Analogue Scale (VAS) in age group 3-14 yrs. A prospective study of 50 children having different intensities of pain was carried out in the Dept. of Pedodontics, Sareetha Dental College and Hospital. 50 children (aged 3-14 yrs) having different intensities of toothache including normal children (control) were included in the study. Saliva samples were collected and Na+, K+ levels in saliva were measured by using Na+, k+ colorimeter kit. Photographs were taken using Digital camera and VAS was prepared accordingly. Sodium levels decreased with increasing pain intensity and potassium levels increased, facial expressions correlated with Na+, K+ levels. Correlation between Na+, K+ levels and pain intensity exists. Also, VAS is a valid measure for pain.

Dental pain prevalence and association with dental caries and socioeconomic status in schoolchildren, Southern Brazil, 2002

O objetivo deste estudo foi investigar as relações entre dor de dente, cárie dentária e condições socio-econômicas em escolares de 12 e 13 anos de idade de uma escola estadual de Florianópolis, SC, Brasil em 2002. Tratou-se de um estudo transversal que envolveu 181 escolares. Episódio de dor de dente foi a variável dependente investigada. Através de um questionário, foram obtidas informações socioeconômicas das famílias. Cárie dentária foi aferida através do índice CPOD. A equipe consistiu de um examinador e um anotador. A análise estatística compreendeu o teste qui-quadrado e a análise de regressão logística múltipla não condicional. A taxa de resposta foi de 93,4%. A concordância intra-examinador para diagnóstico de cárie dentária, medida dente a dente, foi alta (kappa > 0,73). A prevalência de dor de dente foi de 33,7% (IC95% 26,0-42,0). A análise de regressão revelou, após o ajuste pelo sexo e demais variáveis, que crianças com índice CPOD > 1 apresentaram uma chance 2,9 (OR IC95% 1,4-6,1, p < 0,01) maior de ter dor de dente em relação àquelas com índice CPOD < 1. Crianças cujas mães tinham até 4 anos de estudo relataram 2,5 (OR IC95% 1,2-5,6, p = 0,02) mais a chance de dor de dente comparadas às demais que tinham mais de 5 anos de estudo e, finalmente, àquelas de famílias com renda menor que R$ 200,00 mensais apresentaram 3,2 (OR IC95% 1,2-8,4, p = 0,02) vezes mais a chance de apresentarem dor em relação às com renda maior. Alto ataque de cárie dentária, baixa escolaridade materna e baixa renda familiar estiveram associados, independentemente, à dor de dente na população estudada.

Diagnóstico diferencial en endodoncia. Investigación documental / Differential diagnosis in endodontics. Documentary research

Al realizar un diagnóstico endodóntico se presentan signos y síntomas que generan confusión en éste. Ante esta situación, es nuestra intención realizar una investigación documental (libros, revistas, internet y entrevistas) donde se describan dichos signos y síntomas. Autores consultados mencionan algunas patologías como periodontitis apical aguda, oclusión traumática, cefalea en racimo, absceso Periodontal y neuralgia del trigémino entre otras, que presentan una sintomatología similar a las encontradas en una odontalgia por lo que se puede complicar el diagnóstico. Al finalizar la investigación documental se concluye que el dolor dental es el síntoma más común que crea confusión al diagnosticar, pero realizando un diagnóstico exhaustivo, no habrá duda al momento de diferenciar entre una pulpalgia de otra patología.

When making an endodontic diagnosis, signs and symptoms are presented that generate confusion in it. Faced with this situation, it is our intention to carry out a documentary investigation (books, magazines, internet and interviews) where these signs and symptoms are described. Authors consulted mention some pathologies such as acute apical periodontitis, traumatic occlusion, cluster headache, Periodontal abscess and trigeminal neuralgia, among others, which present symptoms similar to those found in odontalgia, which can complicate the diagnosis. At the end of the documentary research, it is concluded that dental pain is the most common symptom that creates confusion when diagnosing, but making an exhaustive diagnosis, there will be no doubt when differentiating between a pulpalgia from another pathology.