Awareness, Knowledge and Attitudes Toward Management of Avulsed Permanent Incisors Among Primary School Teachers.

Introduction: Dental trauma is known as main concern for public health and is a prevalent issue among children as it leads to functional, aesthetic, and psychological complications. This study aimed to evaluate the awareness and knowledge of primary school teachers regarding emergency first aid management for tooth avulsion at Agadir. Methods: The study was conducted in 46 randomly selected primary schools in Agadir and included all teachers from these schools. Data collection was carried out through a self-administered questionnaire focusing on teachers' socio-demographic characteristics, understanding of the importance of emergency management and familiarity with emergency procedures. Data analysis was performed using Jamovi Version 2.3.21.0. Results: A total of 202 teachers participated in the study, 61% being female and 39% male. It has been found that 59.4% of the teachers had encountered an avulsed tooth accident at school. Of these, 23.9% indicated they would immediately replant the avulsed tooth, while 76.7% would contact the child's parents. Regarding storage, 6.8% would preserve the avulsed tooth in milk, while 30.1% preferred using paper. No significant differences were found in term of seniority and age groups (p>0.05). Discussion: An educational programs is needed to enhance the management and prognosis of permanent tooth avulsion among children in Morocco.

In Vitro Methods for Assessing the Antibacterial and Antibiofilm Properties of Essential Oils as Potential Root Canal Irrigants-A Simplified Description of the Technical Steps.

BACKGROUND: Essential oils have gained in significance due to their various biological activities, and there is a growing demand for them in many industries. The present article focuses on the technical steps for an in vitro evaluation of the antibacterial and antibiofilm activities of essential oils for potential use as root canal irrigant in dentistry. METHODS: The bioactivities of the essential oil were investigated through in vitro assays. The gram-positive bacterium Enterococcus faecalis was used as a micro-organism model. The antibacterial activity of the essential oil was assessed using the microdilution method, and resazurin staining to determine the minimal inhibition concentrations (MICs) and the minimal bactericidal concentrations (MBCs). The antibiofilm effect was evaluated spectrophotometrically at 570 nm using the microplate cultivation technique and crystal violet staining. CONCLUSIONS: This article features a detailed in vitro protocol to facilitate the preparation of the essential oil samples, the bacterial suspension, and the methods used for assessment of the antibiofilm and antibacterial activities of the essential oil. The advantages of these approaches are presented in relation to the limits linked to the choice of the bacteria and the essential oil.

Mandibular Second Molars and Their Pathologies Related to the Position of the Mandibular Third Molar: A Radiographic Study.

Objective: The aim of this study was to determine the prevalence of mandibular third molar malposition and its impact in relation to the lower second molar using panoramic radiography. Methods and Materials: This was a cross-sectional descriptive study of 353 panoramic images of patients who visited the Dental Clinic of the International University of Rabat. Panoramic images were analyzed in order to determine the number of second molar pathologies associated with the positions of third molars. The following radiographic lesions on the second molar were recorded: caries, root resorption and distal alveolysis. The Chi-square test was used to assess the association between different variables. Results: Of these 353 radiographies, 169 were males, ie, 48%, and 184 were females, ie, 52%. The age range was from 18 to 63 years. The prevalence of the impacted position of the lower third molar was noted in 60%. Distal caries on the second mandibular molar was present in 47.5% of instances having an impacted third molar. Caries was present in 65.5% of wisdom teeth in a normal position and was also present in 79.6% of the impacted teeth. This difference was statistically significant with p = 0.01. The angulation of the third molar is a factor of caries of the second molar: 58.56% of them were carious. Of all the teeth in association with an angulation, 72.03% showed distal alveolysis in the second molar. In addition, root resorption was found in 20.4% of second molars linked to a wisdom tooth in all angulation occurrences. Conclusion: It has been noted that among the pathologies seen on the mandibular second molar, distal alveolysis accounts for the majority of cases (58%), followed by caries (47.5%) and root resorption (13.3%). This study illustrated the importance of performing Orthopantomogram X-rays at each new consultation in patients over the age of 18.

Surgical excision of peripheral giant cell granuloma of the maxilla: a case report.

Peripheral giant cell granuloma (PGCG) is described as an elevated lesion that is located mostly on the gingival mucosa and alveolar crest, consecutive to irritative factors and trauma. It predominantly occurs more in the mandible than the maxilla, and it is usually seen in the 4th to the 6th decades. The clinical appearance of this lesion is red-bluish in color, presenting a similar tissue to the one observed in the liver, usually measuring less than 2 cm. The treatment of the PGCG is the surgical excision. The recurrence of this lesion is rarely described in the literature. The present case highlights the importance of considering the traumatic extractions as one of the main uncommon etiologic factors, leading to the development of peripheral giant cell granuloma. It precisely describes the diagnosis, the treatment of a peripheral giant cell granuloma located in maxillary canine-premolar region, occurred consecutively after ancient traumatic extractions of the 13 and 14 since 1 year. This paper also reports a maxillary location of giant cell granuloma, while the literature reports more commonly the mandibular location. This lesion was excised surgically, and healed uneventually, and in which the follow-up didn´t show any sign of recurrence.

The treatment of mature permanent teeth with irreversible pulpitis by cervical pulpotomy: A systematic review.

Pulpotomy has been used in primary teeth and immature permanent teeth. However, with the advent of new bioactive material, the procedure is shifting towards permanent teeth with mature apices of roots. The objective of this systematic review was to evaluate the success of pulpotomy on mature permanent teeth with acute irreversible pulpitis and to compare it with root canal treatment or between the effectiveness of the bioactive material used. The following databases were searched: PubMed, Cochrane Library: Cochrane Central Register of Controlled Trials, Embase, ClinicalTrials.gov, International Clinical Trials Registry Platform. After using the keywords predefined, the electronic search yielded a total of 86 articles. After undergoing a thorough screening and eligibility process, only four articles were finally selected. Unexpectedly, pulpotomy demonstrated a better tendency for success in such cases over the years. This shows that pulpotomy is not inferior to root canal treatment for permanent treatment of irreversible pulpitis. In addition, the results obtained showed that pulpotomy is rapid, biologically reliable and more cost-effective in all situations compared to root canal therapy. Complete pulpotomy appears to have a high success rate as a permanent treatment of irreversible pulpitis and could be considered as an alternative to root canal therapy. Pulpotomy is not inferior to root canal treatment for a permanent treatment of irreversible pulpitis. In addition, the results obtained have shown that complete pulpotomy is faster and more profitable in all situations compared to root canal treatment. Furthermore, with the advent of new so-called bioactive materials, the use of this therapeutic is increasingly considered. This is why a review based on studies of reliable articles is above all necessary to be able to generalise the indication of this therapy.

Reasons behind permanent tooth extraction at a dental university hospital in Morocco: a survey among patients of the International Faculty of Dental Medicine of Rabat.

Introduction: this cross-sectional study aimed to investigate the factors contributing to tooth extractions and possible correlations between tooth loss and various variables. Methods: the study took place at the dental university hospital affiliated with the International University of Rabat over a period of two months (December 15th, 2020, to February 15th, 2021). The data collected has been recorded from patients who had tooth extraction procedures. The variables analyzed included age, gender, and the reason for extraction. To analyze the significance of the variables Chi-square test was used, and to investigate the variance in the mean number of teeth extracted per patient ANOVA was used. Results: in 159 patients with different ages, a total of 586 permanent teeth were extracted. Men had an extraction rate of 54.5% while women formed 45.5%. Overall, the most frequent reason for tooth extraction was caries (46.28%), and periodontal diseases (44.90%). Other reasons for extraction included prosthetics (4.31%) and aesthetics (2.7%). However, orthodontics reasons were not observed. The topmost tooth extraction rate per patient was seen in the 41 to 50-year-old age group with a mean of 4.22 teeth. Analysis of the reasons for extraction by gender did not show a statistically significant difference (p>0.29). Conclusion: caries and periodontal disease were the main causes of tooth extractions. Improving oral prevention health programs can help patients maintain healthier and functional oral health throughout their lives.

Combined Epidemiologic and Entomologic Survey to Detect Urban Malaria Transmission, Guinea, 2018.

Malaria incidence is generally lower in cities than rural areas. However, reported urban malaria incidence may not accurately reflect the level of ongoing transmission, which has potentially large implications for prevention efforts. To guide mosquito net distribution, we assessed the extent of malaria transmission in Conakry, Guinea, in 2018. We found evidence of active malaria transmission.

[Pneumatisation of the temporal articular eminence: radiographic study in a Senegalese population]. / Pneumatisation de l'eminence articulaire temporale : etude radiographique dans une population Senegalaise.

INTRODUCTION: Pneumatisation of the zygomatic air cell defect (ZACD) is a rarely seen anatomical variation, a chance discovery but relevant in the planning of temporomandibular joint surgery. The objective of this work was to study the presence and radiographic aspects of pneumatization of the zygomatic process of the temporal bone in a Senegalese population. MATERIAL AND METHODS: The study was a descriptive cross-sectional study of 444 panoramic radiographs of Senegalese patients in an age range from 5 to 86 years. The presence of ZACDs was confirmed by the presence of a clear radio image at the level of the eminence articulaire de los temporal, they were classified into unilocular, multilocular and trabecular types. RESULTS: A prevalence of 7.8% was noted. The multilocular aspect was the most common with 54.3%, followed by the unilocular aspect with 40%. The ZACDs were in 54.3% bilateral and 45.7% in unilateral localization. CONCLUSION: This work highlighted this rare and fortuitous anatomical variation of discovery during a panoramic radiological examination in a Senegalese population. Further longitudinal studies are necessary for a better understanding of the pneumatization of the eminence of the joint in the diagnostic and therapeutic process involving the temporomandibular joint.

INTRODUCTION: La pneumatisation de l'éminence zygomatique en anglais zygomatic air cell defect (ZACD) est une variation anatomique rare, de découverte fortuite mais pertinente dans la planification de la chirurgie de l'articulation temporo-mandibulaire. L'objectif de ce travail était d'étudier les aspects radiographiques de la pneumatisation du processus zygomatique de l'os temporal dans une population sénégalaise. MATÉRIEL ET MÉTHODES: L'étude était de type transversal descriptif portant sur 444 radiographies panoramiques de patients sénégalais d'une tranche d'âge comprise entre 5 et 86 ans. La présence des ZACD était confirmée par la présence d'une image radio claire nette au niveau de l'éminence articulaire de los temporal, ils étaient classés en types uniloculaire, multiloculaire et trabéculaire. RÉSULTATS: Une prévalence de 7,8% était notée. L'aspect multiloculaire était le plus rencontré avec 54,3% suivi de l'aspect uniloculaire avec 40%. Les ZACD étaient dans 54,3% bilatérales et 45,7% en localisation unilatérale. CONCLUSION: Ce travail a mis en exergue cette variation anatomique de découverte rare et fortuite lors d'un examen radiologique panoramique dans une population sénégalaise. D'autres études longitudinales sont nécessaires pour une meilleure connaissance de la pneumatisation de l'éminence articulaire dans le processus diagnostique et thérapeutique impliquant l'articulation temporo-mandibulaire.

Evaluating the quality of routinely reported data on malaria commodity stocks in Guinea, 2014-2016.

BACKGROUND: Ensuring malaria commodity availability at health facilities is a cornerstone of malaria control. Since 2013, the Guinea National Malaria Control Programme has been routinely collecting data on stock levels of key malaria commodities through a monthly routine malaria information system (RMIS). In parallel, biannual end-user verification (EUV) surveys have also assessed malaria commodity availability at a subset of health facilities, potentially representing a duplication of efforts. METHODS: Data on 12 malaria commodity stock levels verified during four EUV surveys conducted between 2014 and 2016 was compared to data for the corresponding months submitted by the same health facilities through the RMIS. The sensitivity and specificity of the RMIS in detecting stock-outs was calculated, as was the percent difference between average stock levels reported through the two systems. RESULTS: Of the 171 health facilities visited during the four EUV surveys, 129 (75%) had data available in the RMIS. Of 351 commodity stock-outs observed during the EUV in the sampled reporting health facilities, 256 (73%) were also signaled through the corresponding RMIS reports. When the presence of malaria commodity stocks was confirmed during the EUV surveys, the RMIS also reported available stock 87% (677/775) of the time. For all commodities, the median percent difference in average stock levels between the EUV and RMIS was 4% (interquartile range - 7 to 27%). CONCLUSION: The concordance between stock levels reported through the RMIS and those verified during the EUV visits provides certain evidence that RMIS data can inform quantification and procurement decisions. However, lower than acceptable rates of reporting and incomplete detection of stock-outs from facilities that do report suggest that further systems strengthening is needed to improve RMIS reporting completeness and data quality.

Evaluation of the mono instrument (Wave One) mechanical action on the bacterial load reduction: In vitro study of 32 permanent human teeth.

CONTEXT: Enterococcus faecalis is the most common bacteria found in infected root canals. AIM: The purpose of this study was to evaluate the effect of the mono instrument (wave-one®) on the reduction of E. faecalis in root canals. MATERIALS AND METHODS: Thirty-two human monoroot teeth were used. After sterilization by autoclave, the teeth were infected by E. faecalis and incubated for 24 h. Each tooth underwent sampling before and after the root canal shaping. After serial dilution, samples were incubated, and colony-forming units were counted. RESULTS: The mono instrument technique reduced infection by E. faecalis in root canals of 30 teeth. The mean bacterial load (log10) was 3.98 before treatment and 1.20 after treatment. The paired t-test showed a significant mean difference (log10) of the bacterial load before and after treatment (P < 0.0001). CONCLUSION: This study found that the mono instrument (Wave One®) significantly decreases bacterial load in root canals. However, the instrument alone is not enough to eradicate infections; thus, the use of a complementary antimicrobial is required.

Bonding effectiveness of self-etch adhesives to dentin after 24 h water storage.

PURPOSE: This study evaluated the immediate bonding effectiveness of five self-etch adhesive systems bonded to dentin. MATERIALS AND METHODS: The microtensile bond strength of five self-etch adhesives systems, including one two-step and four one-step self-etch adhesives to dentin, was measured. Human third molars had their superficial dentin surface exposed, after which a standardized smear layer was produced using a medium-grit diamond bur. The selected adhesives were applied according to their respective manufacturer's instructions for µTBS measurement after storage in water at 37°C for 24 h. RESULTS: The µTBS varied from 11.1 to 44.3 MPa; the highest bond strength was obtained with the two-step self-etch adhesive Clearfil SE Bond and the lowest with the one-step self-etch adhesive Adper Prompt L-Pop. Pretesting failures mainly occurring during sectioning with the slow-speed diamond saw were observed only with the one-step self-etch adhesive Adper Prompt L-Pop (4 out of 18). CONCLUSIONS: When bonded to dentin, the self-etch adhesives with simplified application procedures (one-step self-etch adhesives) still underperform as compared to the two-step self-etch adhesive Clearfil SE Bond.

Trigemino-gustatory interactions: a randomized controlled clinical trial assessing the effects of selective anesthesia of dental afferents on taste thresholds.

OBJECTIVES: This study aimed at analyzing the effect of the temporary removal of trigeminal dental afferents on electrogustometric thresholds (EGMt). MATERIAL AND METHODS: EGMt were measured in 300 healthy subjects randomized in three groups, in nine loci on the right and left side (RS, LS) of the tongue surface before and after anesthesia. Group IAN (n = 56 RS, n = 44 LS) received intraosseous local anesthesia of the inferior alveolar nerve (IAN). Group MdN received mandibular nerve (MdN) block targeting IAN before its entrance into the mandibular foramen (n = 60, RS, and n = 40, LS); group MxN receiving maxillary nerve (MxN) anesthesia (n = 56 RS and n = 44 LS) was the control group. Differences between mean EGMt were analyzed with the Wilcoxon test; correlation between type of anesthesia and EGMt was performed with Spearman's rho, all with a level of significance set at p ≤ 0.05. RESULTS: Significant EGMt (µA) differences before and after anesthesia were found in all loci with MdN and IAN on the ipsilateral side (p < 0.05), but not with MxN. Anesthesia of the MdN was positively correlated with the increase in EGMt (p < 0.001). Selective anesthesia of IAN was positively correlated only with the increase in EGMt measured at posterior and dorsal loci of the tongue surface (p < 0.01). CONCLUSION: The increase in EGMt following IAN anesthesia suggests a participation of dental afferents in taste perception. CLINICAL RELEVANCE: Extraction of teeth may impair food intake not only due to impaired masticatory ability but also to alteration of neurological trigemino-gustatory interactions. TRIAL REGISTRATION NUMBER: PACTR201602001452260.

Place de la radiologie dans la pratique des chirurgiens-dentistes sénégalais

L'odontologie a naturellement bénéficié des innovations en imagerie médicale. L'examen radiologique est devenu une partie intégrante de la prise en charge odontologique. Ce travail avait pour objectif d'évaluer la place de la radiologie dans la pratique des chirurgiens-dentistes sénégalais.Matériels et méthodes.Il s'agissait d'une étude transversale descriptive réalisée auprès des chirurgiens-dentistes exerçant dans les secteurs du privé, et du public de la région de Dakar. Des questionnaires auto-administrés ont été distribués afin de recueillir les informations suivantes : le secteur d'activité, l'importance de la radiologie dans la pratique quotidienne, l'équipement en appareil radiologique, la fréquence de prescription des examens radiologiques. Les données ont été analysées avec le test chi-deux.RésultatsAu total, 132 chirurgiens-dentistes ont répondu aux questionnaires. Parmi eux 42% exerçaient dans le secteur privé, 28% dans le public et 20% étaient des praticiens hospitalo-universitaires. Le sexe ratio était de 2,14 et la moyenne d'âge était de 37 ans ± 11.Plus de 90% des chirurgiens-dentistes accordaient une grande importance aux examens d'imagerie dans leur pratique, 6,84% une importance moyenne. Les films argentiques étaient les plus utilisés avec 75% contre 25% de récepteurs numériques. Les examens radiologiques n'étaient prescrits de manière systématique que par 6,87% des chirurgiens-dentistes alors que 64,84% les prescrivaient de manière sélective et 27% utilisaient rarement.Conclusion: Cette étude a montré une insuffisance d'équipement radiologique et une attitude inadéquate de prescription des examens radiologiques des chirurgiens-dentistes de la région de Dakar Des formations continues en radiologie dentaire s'avèrent nécessaire pour une meilleure connaissance des examens radiologiques

Characteristics of pain assessed with visual analog scale and questionnaire in burning mouth syndrome patients: a pilot study.

AIMS: To test the validity of the use of the Douleur Neuropathique en 4 Questions (DN4) questionnaire for burning mouth syndrome (BMS) patients, and to differentiate patients by measuring the time course of the pain in BMS patients over a period of 7 days with a visual analog scale (VAS). METHODS: Patients completed the DN4 questionnaire and a VAS every hour for 7 days. The data were expressed as mean ± SEM. Correlations were searched using the Spearman correlation test with a significance level at P < .05. RESULTS: Data were fully analyzed for the 22 patients (21 females, 1 male, mean [± SEM] age 62.7 ± 2.3 years) for the DN4 and 17 patients for the VAS. DN4 scores ranged from 2 to 7 (mean score: 3.9 ± 0.3), and 59% of the patients had a DN4 score ≥ 4. Burning was found in all the patients, followed by pricking pain (pins and needles) and allodynia (pain on brushing) (both 68%), tingling (45%), numbness (32%), itching (27%), and electrical discharges (23%). Monitoring the hourly time-course of the pain led to the identification of two groups with intermittent or constant pain. In the latter, averaging the VAS for 7 days enabled plotting a curve, the slope of which could be calculated. The range of the slopes was 0.00 to 0.59, and a regular increase of pain during the day was seen for the majority of the patients. CONCLUSION: The findings support the use of DN4 as a tool for screening BMS and reinforce the view that BMS is a clinical manifestation of a neuropathic disease. The methodology of this study can be used for a better description of the patients and the identification of subgroups.

Acute apical periodontitis and vertical root fracture of the same tooth: a case report.

Vertical root fracture is a frequent complication in endodontically treated teeth and usually leads to extraction of the affected tooth. Differential diagnosis may be difficult, especially in patients with periodontal and endodontic disease. This case report describes the diagnosis and clinical and radiographic features of apical periodontitis and vertical root fracture of the same tooth, which were separated by an interval of several years. Vertical root fracture of the mesial root was diagnosed with the help of an exploratory flap and microscopic observation.

[Pharmacovigilance among dentists: a survey of practitioners in Dakar, Senegal]. / Pharmacovigilance chez les chirurgiens-dentistes: enquête dans la région de dakar, Sénégal.

AIM: Since 1968, the World Health Organization has used an international pharmacovigilance programme to monitor and examine the effects of drugs. The purpose of this study was to assess the knowledge and attitudes of dentists toward pharmacovigilance. METHODS: The paper presents the results of a cross-sectional descriptive study of 103 dentists in Senegal, based on an exhaustive selection process. Data were collected on the dentists' sociodemographic characteristics and their knowledge and attitudes toward pharmacovigilance. RESULTS: Over 50% of the sample were general practitioners. The average number of years of professional experience was 9 years. Painkillers (41.9%) were the most widely prescribed drugs, followed by antibiotics, which were particularly involved in the onset of adverse effects (41.8%). Adverse effects were observed by just 3.8% of the sample. Almost 90% of the participants were not aware of the existing pharmacovigilance system. CONCLUSION: The results suggest that pharmacovigilance training and education sessions for dentists are needed to improve their knowledge of pharmacovigilance and to foster positive attitudes toward adverse effects.

Glutamate control of pulpal blood flow in the incisor dental pulp of the rat.

Glutamate is present in primary sensory afferents innervating the dental pulp and is known to exert vasoactive effects. The aims of this study were (i) to assess pulpal blood flow (PBF) after glutamate infusion in the dental pulp and (ii) to observe the distribution of glutamatergic nerve fibers expressing the vesicular transporters of glutamate (VGluT). The PBF was monitored with laser Doppler flowmetry before and after glutamate (0.5 M) infusion in the dental pulp vs. saline infusion. Immunochemistry for VGluT1, 2, and 3 was performed in addition to immunochemistry for the vascular and neuronal markers smooth-muscle actin (SMA), isolectin B4 (IB4), and calcitonin gene-related peptide (CGRP). Glutamate infusion resulted in a PBF increase that lasted for 60 s. Positive immunolabeling was observed for the three glutamate transporters, but was more pronounced for VGluT3. Moreover, VGluT3 immunoreactivity was observed within nerve fibers entering the dental pulp and terminating at the periphery and at the vicinity of odontoblasts. Also, VGluT3 was colocalized with the vascular marker SMA, and in some nerve fibers with IB4, but not with CGRP. This study provides support for a control of dental pulp microcirculation by neurons expressing VGluT3.

Analysis of reasons for extraction of endodontically treated teeth: a prospective study.

INTRODUCTION: The purpose of this prospective study was to analyze the factors related to extraction of endodontically treated teeth. METHODS: One hundred nineteen cases of extraction of endodontically treated teeth were consecutively reviewed, and the following items were recorded: type of tooth; presence and type of coronal restoration; motive of consultation; reasons for extraction; patient's age, gender, level of education; smoking status. Association between factors was investigated with χ(2) analysis. RESULTS: Dental pain was the main motive for consultation (68.9%). The teeth most extracted were mandibular molars (51.3%), followed by maxillary molars (16.1%). First molars were the most frequently extracted (29.4%). Ninety-one teeth (76.5%) were restored coronally with or without post, and crowned teeth represented 5.9% of the sample. The reasons for extraction were periodontal disease (40.3%), endodontic failure (19.3%), vertical root fracture (13.4%), nonrestorable cuspid and crown fracture (15.1%), nonrestorable caries (5.2%), iatrogenic perforations and stripping (4.2%), and prosthetic (0.8%). Analysis between gender, smoking status, and education level showed no significant difference for reasons of extraction (P = .33 and .34). CONCLUSIONS: The mandibular first molar without crown was the most frequently extracted tooth. The main reasons for extractions were periodontal disease, endodontic failure, and nonrestorable tooth damage caused by fracture or caries.

Preoperative pain and medications used in emergency patients with irreversible acute pulpitis or acute apical periodontitis: a prospective comparative study.

AIMS: To determine the pain characteristics of and medications used for patients seeking emergency care for irreversible acute pulpitis (IAP) or acute apical periodontitis (AAP). METHODS: General (age, sex, weight, general health) and specific (pain intensity, localization, tooth mobility, lymphadenopathy, use of medications) information was noted in 209 patients who appeared for emergency care in 2 dental centers of Dakar with either IAP or AAP. Statistical analysis was performed with the Mann-Whitney and chi-square tests. RESULTS: The sample comprised 97 IAP patients (46.4%) and 112 AAP patients (53.6%); there were no significant differences between the 2 groups with respect to age, sex, or weight. Of the involved teeth, 62% were mandibular and 38% were maxillary. IAP patients waited 6.6 +/- 5.3 days before seeking an emergency consultation versus 5.0 +/- 3.8 days for AAP patients (P < .05). Severe pain was reported in 75% of the IAP and 76% of AAP patients (not significant). Percussion and apical palpation were painful only in AAP, in 98% and 40% of patients, respectively. Mobility and adenopathies were noted only in AAP, in 87% and 46% of patients, respectively (P < .001). Seventy-five percent of IAP patients and 80% of AAP patients used medications, mainly non-narcotic analgesics, which offered relief in 62% of IAP patients and 46% of AAP patients. CONCLUSIONS: Patients with IAP waited longer than those with AAP before seeking treatment. Self-medication offered better relief in cases of IAP than in cases of AAP. Pain to percussion and palpation, lymphadenopathies, and dental mobility were strong indicators for AAP.