Psychometric Properties of the Multidimensional Pain Inventory Applied to Brazilian Patients with Orofacial Pain.

AIMS: To evaluate the psychometric properties of the Multidimensional Pain Inventory (MPI) in a Brazilian sample of patients with orofacial pain. METHODS: A total of 1,925 adult patients, who sought dental care in the School of Dentistry of São Paulo State University's Araraquara campus, were invited to participate; 62.5% (n=1,203) agreed to participate. Of these, 436 presented with orofacial pain and were included. The mean age was 39.9 (SD=13.6) years and 74.5% were female. Confirmatory factor analysis was conducted using χ²/df, comparative fit index, goodness of fit index, and root mean square error of approximation as indices of goodness of fit. Convergent validity was estimated by the average variance extracted and composite reliability, and internal consistency by Cronbach's alpha standardized coefficient (α). The stability of the models was tested in independent samples (test and validation; dental pain and orofacial pain). The factorial invariance was estimated by multigroup analysis (Δχ²). RESULTS: Factorial, convergent validity, and internal consistency were adequate in all three parts of the MPI. To achieve this adequate fit for Part 1, item 15 needed to be deleted (λ=0.13). Discriminant validity was compromised between the factors "activities outside the home" and "social activities" of Part 3 of the MPI in the total sample, validation sample, and in patients with dental pain and with orofacial pain. A strong invariance between different subsamples from the three parts of the MPI was detected. CONCLUSION: The MPI produced valid, reliable, and stable data for pain assessment among Brazilian patients with orofacial pain.

A retrospective radiographic study on the effect of natural tooth-implant proximity and an introduction to the concept of a bone-loading platform switch.

PURPOSE: The aim of this study was to evaluate the effect of tooth-implant proximity using an implant system with a double platform shift that was designed to load bone coronal to the implant-abutment cohort study was conducted between January 2008 and December 2009. The sample was composed of patients who had received at least one 5-mm-wide hydroxyapatite-coated single-tooth Bicon implant that had been placed adjacent to at least one natural tooth. Descriptive statistics and univariate and multivariate linear mixed-effects regression models, adjusted for multiple implants in the same patient, were utilized. The primary predictor variable was the horizontal distance between implant and adjacent tooth, and the primary outcome variable was the change in peri-implant bone levels over time. RESULTS: Two hundred six subjects who received 235 plateau root-form implants were followed for an average of 42 months. Tooth-implant distance ranged between 0 and 14.6 mm. Out of 235 implants, 43 implants were placed < 1 mm to an adjacent natural tooth on mesial and/or distal sides. The proximity of a plateau root-form implant was not associated with complications on the adjacent tooth such as bone loss, root resorption, endodontic treatment, pain, or extraction. The proximity of an adjacent tooth was not a risk factor for the failure of a plateau root-form implant. After adjusting for other covariates in a multivariate model, the proximity of a natural tooth did not have a statistically significant effect on peri-implant bone levels (P = .13). The extraction of an adjacent tooth was associated with a significant increase in peri-implant bone loss (P = .008). CONCLUSION: The placement of a plateau root-form implant with a sloping shoulder in close proximity to an adjacent tooth did not cause damage to that tooth or lead to bone loss or the failure of the implant.

Systematic review and recommendations for nonodontogenic toothache.

Nonodontogenic toothache is a painful condition that occurs in the absence of a clinically evident cause in the teeth or periodontal tissues. The purpose of this review is to improve the accuracy of diagnosis and the quality of dental treatment regarding nonodontogenic toothache. Electronic databases were searched to gather scientific evidence regarding related primary disorders and the management of nonodontogenic toothache. We evaluated the level of available evidence in scientific literature. There are a number of possible causes of nonodontogenic toothache and they should be treated. Nonodontogenic toothache can be categorised into eight groups according to primary disorders as follows: 1) myofascial pain referred to tooth/teeth, 2) neuropathic toothache, 3) idiopathic toothache, 4) neurovascular toothache, 5) sinus pain referred to tooth/teeth, 6) cardiac pain referred to tooth/teeth, 7) psychogenic toothache or toothache of psychosocial origin and 8) toothache caused by various other disorders. We concluded that unnecessary dental treatment should be avoided.

Oral pre-trigeminal neuralgia pain: clinical differential diagnosis and descriptive study results.

AIMS: To better quantify oral pre-trigeminal neuralgia (PTN) symptoms, attempt to identify PTN symptoms that could reliably differentiate between PTN and odontogenic tooth pain, and determine whether an anesthetic test would reliably differentiate these disorders. METHODOLOGY: This was accomplished through a survey of symptom recall for 49 trigeminal neuralgia patients who had PTN tooth and/or gum pain. RESULTS: The variability of oral PTN symptoms, factors that worsened or improved them, and how dental anesthesia affected them, explain the reason for variations found in the literature. A throbbing pain quality is not in the literature, but present for 63% of respondents. CONCLUSIONS: No specific PTN symptom would reliably differentiate PTN from odontogenic tooth pain. The results also suggest that an anesthetic test would not be totally reliable for differentiating these disorders. A protocol is provided that should help practitioners identify the tooth pain source when there is no dental pathology.

Response of human dental pulp capped with biodentine and mineral trioxide aggregate.

INTRODUCTION: Biodentine is a new bioactive cement that is similar to the widely used mineral trioxide aggregate (MTA). It has dentin-like mechanical properties, which may be considered a suitable material for clinical indications of dentin-pulp complex regeneration such as direct pulp capping. The purpose of the present study was to compare the response of the pulp-dentin complex in human teeth after direct capping with this new tricalcium silicate-based cement with that of MTA. METHODS: Pulps in 28 caries-free maxillary and mandibular permanent intact human molars scheduled for extraction for orthodontic reasons were mechanically exposed and assigned to 1 of 2 experimental groups, Biodentine or MTA, and 1 control group. Assay of periapical response and clinical examination were performed. After 6 weeks, the teeth were extracted, stained with hematoxylin-eosin, and categorized by using a histologic scoring system. RESULTS: The majority of specimens showed complete dentinal bridge formation and an absence of inflammatory pulp response. Layers of well-arranged odontoblast and odontoblast-like cells were found to form tubular dentin under the osteodentin. Statistical analysis showed no significant differences between the Biodentine and MTA experimental groups during the observation period. CONCLUSIONS: Within the limitations of this study, Biodentine had a similar efficacy in the clinical setting and may be considered an interesting alternative to MTA in pulp-capping treatment during vital pulp therapy.

Persistent dentoalveolar pain: the patient's experience.

AIMS: To build an understanding of the patient's experience and from this identify recurring themes that could form part of an item pool for further testing of persistent dentoalveolar pain disorder (PDAP). METHODS: Proven cases of PDAP were identified from a clinical database, and a purposive maximum variation sample was drawn. Semi-structured interviews were conducted with the sample by a single trained interviewer. Interviews were digitally recorded and transcribed verbatim. Data collection and analysis occurred until data saturation (n = 20), with no new themes emerging. Analysis of the data was an iterative and inductive process broadly following the principles of the constant comparative method. RESULTS: Recurrent themes emerging from the data were: difficulty in responding to history taking; duration and magnitude of pain; complex and confounding descriptors; common exacerbating factor; well-localized pain; deep pain; pressurized or pressure feeling. CONCLUSION: Several common experiences that can be considered items were identified in the data. These items will add to the limited pre-existing item pool in the literature and allow testing of this item pool to determine those items best suited to form an adjunctive self-report diagnostic instrument for PDAP.

Ranking of dental and somatic pain sensations among paediatric dental patients.

BACKGROUND: Children suffer from somatic and dental pain, which may interfere with their everyday life. Pain self-report tools are available for children. Research is needed to better understand the perception of dental pain in comparison with pain in other organs. AIM: To investigate relations between the perceptions of dental and somatic pain complaints among school-age children. DESIGN: One hundred and two children, aged 7-17 years (mean age, 11.5 ± 2.65 years), completed questioners regarding their somatic and dental: 1. Memory pain rank (MPR) and 2. Wong-Baker FACES Pain Rating Scale (FRS). RESULTS: Children reported increased dental pain after school in both scales (P = 0.015 in MPR). In both MPR and FRS, the pattern of pain ranking was similar: Abdominal pain was scored highest (2.75 ± 1.4 and 1.56 ± 1.63, respectively), followed by headache, ear, dental and TMJ (Temporomandibular joint). CONCLUSION: There was a strong correlation between pain perception and current pain scores in every organ. Somatic pain, namely head, abdomen and ears, was ranked significantly higher than dental and TMJ pain. School-aged children rank current pain and pain experience significantly lower while they are pre-occupied (school time) in comparison with times when they are less busy (after school time).

Dentin caries activity in early occlusal lesions selected to receive operative treatment: findings from the Practitioners Engaged in Applied Research and Learning (PEARL) Network.

BACKGROUND: Members of the practice-based research network Practitioners Engaged in Applied Research and Learning (PEARL) Network investigated the dentin caries activity in early occlusal lesions and its relationship to patient age, preoperative tooth sensitivity and radiographic appearance, as well as its influence on preparation depth and volume. METHODS: PEARL Network practitioner-investigators (P-Is) (n = 45), general dentists who were trained but whose methods were not calibrated, conducted a study regarding postoperative hypersensitivity in resin-based composite restorations. The P-Is enrolled as study participants 613 patients with occlusal carious lesions that, in the P-Is' clinical judgment, required restoration. The P-Is used baseline radiographs to assess the depth and extent of the lesions. Data for 671 restorations included baseline sensitivity; ranking of dentin caries activity on the opening of the enamel; radiographic visibility (n = 652); and measurements of preparation depth, width and length. RESULTS: P-Is found rapidly progressing dentin caries in 38.5 percent (258 of 671) of lesions and slowly progressing (and potentially inactive dentin) caries in the remainder of the lesions. Rapidly progressing caries was not related to the participant's age or participant-reported preoperative hypersensitivity but was related to the lesion depth as seen radiographically (P < .001) and depth (P < .001) and volume (P < .001) of the preparation. Molars had slightly higher but not statistically significant levels of caries activity. CONCLUSION: Rapidly progressing dentin caries, while present in only 38.5 percent of lesions, was related to the lesion's radiographic appearance but not to the participant's age or the study tooth's pre-operative sensitivity. CLINICAL IMPLICATIONS: On the basis of the low level of rapidly progressing dentin caries in this study population and the fact that slowly progressing caries can be inactive or remineralizing, the authors advise sealing versus operative treatment of early or shallow occlusal lesions.

Validation of a child dental pain questionnaire instrument for the self-reporting of toothache in Children.

PURPOSE: The purpose of the present study was to test the reliability and validity of a novel child dental pain questionnaire (child-DPQ). METHODS: The child-DPQ is structured to measure toothache using 3 subscales: (1) prevalence; (2) severity; and (3) impact on daily life. It was tested on 174 8- and 9-year-old children. The instrument's reliability was assessed by testing internal and test-retest consistency, and its validity was assessed by testing construct and discriminant validity. Specifically, discriminant validity was tested by comparing the mean scores of 2 clinical groups: (1) absent or treated caries (N =110); and (2) untreated caries (N =64). RESULTS: Internal consistency was confirmed by a Cronbac's alpha coefficient of 0.93. Test-retest reliability was found to be highly reproducible (intraclass correlation coefficient=0.99). The construct validity was satisfactory, demonstrating highly significant correlations among the global indicator, the total score, and subscale scores (P<.001). The child-DPQ score was able to discriminate between the 2 clinical groups (P<.001). CONCLUSION: The present study provides evidence for the reliability and validity of the child dental pain questionnaire in assessing the impact of toothache on the daily life of children.

Pain prevalence and severity before, during, and after root canal treatment: a systematic review.

INTRODUCTION: Anticipation and experience of root canal associated pain is a major source of fear for patients and a very important concern of dentists. Pretreatment, treatment, and posttreatment pain is anticipated, experienced, remembered, and shared by patients. The purpose was to determine the influence of root canal treatment on pain prevalence and severity and estimate the prevalence and severity of pretreatment, treatment, and posttreatment pain in patients receiving root canal treatment. METHODS: Defined searching of MEDLINE, Embase, Cochrane, and PsycINFO databases identified 5,517 articles. Systematic review, including title scanning, abstract scanning, full-text review, and quality rating, provided 72 studies for meta-analysis. L'Abbe plots were used to evaluate the influence of root canal treatment on pain prevalence and severity. Pretreatment, treatment, and posttreatment pain prevalence and severity data were analyzed. RESULTS: L'Abbe plots revealed that pain prevalence and severity decreased substantially after treatment. Mean pretreatment, 24-hour posttreatment, and 1-week posttreatment pain prevalences with associated standard deviations were 81 (28%), 40 (24%), and 11 (14%), respectively. Pretreatment, 24-hour posttreatment, and 1-week posttreatment pain severities, on a 100-point scale, were 54 (24%), 24 (12%), and 5 (5%), respectively. Supplemental injections were frequently required (60 [24%]). CONCLUSIONS: Pretreatment root canal-associated pain prevalence was high but dropped moderately within 1 day and substantially to minimal levels in 7 days. Pretreatment root canal-associated pain severity was moderate, dropped substantially within 1 day of treatment, and continued to drop to minimal levels in 7 days. Supplemental anesthesia was often required.

Pulpotomy to stainless steel crown ratio in children with early childhood caries: a cross-sectional analysis.

PURPOSE: This study's purpose was to determine the pulpotomy-to-crown ratio (PCR) in a high-early childhood caries patient population and factors associated with choice of pulpotomy and crown treatments. METHODS: This was a retrospective quality assurance chart review. Five calibrated examiners (kappa=0.86) rated radiographic caries from available films. Demographic data, including age, health status, medications, and pain score, were collected along with pulpotomy- and crown-related treatment characteristics of location of tooth, treatment site, and level of operator skill. RESULTS: The record review of 521 patients (mean age=5.1 ± 1.9 years old) revealed 1,365 stainless steel crowns (SSCs) performed with 461 pulpotomies in a 6-month period, in both operating rooms (1,043 SSCs) and ambulatory settings (322 SSCs). The mean PCR was 0.34, with PCR decreasing with increasing patient age. Pulpotomy and crown treatments increased with radiographic caries severity with a significant association between pulpotomy and radiographic severity (P<.001). More severe pain was associated with greater likelihood of pulpotomy (P<.001). Age, operator type, and site of treatment did not affect choice of pulpotomy. CONCLUSIONS: The mean pulpotomy-to-crown ratio in this high-early childhood caries pediatric population was 0.34. Pain, the American Society of Anesthesiologists classification system, and radiographic caries severity were predictors of pulpotomy, but operator type and location of treatment were not.

Associations among sleep disturbance, vitality, fatigue and oral health.

PURPOSE: The objective of the present study was to explore the moderating effects of sleep disturbance, fatigue and vitality on self-reported oral-health status and oral-health related behaviours. MEASUREMENTS AND RESULTS: The present study sample consisted of 213 first-year dental students at the University of Medicine and Pharmacy 'Carol Davila', Bucharest, Romania. The questionnaire included information about sociodemographic factors, behavioural variables and self-reported oral-health status. Subjective Vitality Scale, Fatigue Assessment Scale and Karolinska Sleep Questionnaire were used to assess quality of sleep, vitality and fatigue. The duration of sleep in 41.2% of students was < 7 h per night. It was revealed that 11.7% of the students experienced daily disturbed sleep, 20.4% had daily premature awakening and 50.5% presented frequent difficulties awakening. Significant differences were found among disturbed sleep, impaired awakening, vitality and fatigue scales according to several variables: perceived dental health, satisfaction by appearance of own teeth, self-reported gingival condition, mouth rinse frequency and reason for the dental visit, while multiple linear regression analyses revealed that vitality and impaired awakening were independent determinants of self-rated oral and gingival health status. Disturbed sleep index, impaired awakening, fatigue and vitality were positively associated with oral-health related behaviours. CONCLUSIONS: The authors concluded that the disturbed sleep index, impaired awakening, fatigue and vitality were associated with oral-health status and behaviour.

Validation of a dental pain screening questionnaire in a semi-urban hospital setting in South India.

AIMS: To assess the validity of modified DePaQ items in correctly classifying dental pain patients into three groups of common dental conditions when compared against clinically-determined classification; generate a model of classification equations from a sub-population of the sample; and assess the validity of the model in predicting group membership of new dental pain cases. METHODS: Consecutive adult hospital dental patients aged 18 years and older attending with a dental pain complaint were diagnosed by a dentist. Before treatment commenced a self-complete questionnaire was completed. The examining dentist was blinded to the questionnaire responses. The sample was randomly split into two groups (RS1 and RS2). Discriminant analysis was carried out on RS1 to develop a model for classifying new dental pain cases into three groups. This model was used to classify dental pain cases in RS2. RESULTS: Of the 311 questionnaires distributed, 306 (98.4%) were returned. Of the 205 Group 1 cases diagnosed clinically 186 (90.7%) were correctly predicted as belonging to that group by M-DePaQ. For 54 clinically diagnosed Group 2 cases 44 (81.5%) were correctly predicted, and for 32 Group 3 cases, 26 (81.3%) were correctly predicted. The model of classification equations derived from RS1 were capable of correctly classifying 85%, 82% and 79% of clinically-derived classification for Group 1, 2 and 3 respectively. CONCLUSIONS: This study has demonstrated that the M-DePaQ is valid in classifying dental pain patients into three groups of common dental conditions. Classification equations generated from a sub-group of the sample provided a valid statistical model for classifying dental pain cases from the same setting.

[Suggestion for a classification of odontalgias]. / Vorschlag einer Klassifikation der Odontalgien.

BACKGROUND: Toothache prevalence in the overall population is considerable. However, for clinical purposes, the classification schemes available do not appear to be sufficiently sophisticated. Moreover, not all known forms of dental pain are considered. A refined classification that meets current standards is therefore introduced. To facilitate diagnosis, the characteristic features of the various types of odontalgia are summarized. RESULTS: The new classification differentiates among seven different origins of pain: 1. dentinal pain (originating from the pulpal tissues), 2. pulpal pain (originating from the pulpal tissues), 3. periodontal pain, 4. alveolar-osseous pain, 5. atypical odontalgia, 6. heterotopic dental pain, 7. odontalgia associated with primary psychosocial factors. CONCLUSIONS: In our opinion, the proposed classification differentiates among the different forms of odontalgia more precisely than all previous ones. However, its viability and advantages over other available classification schemes still need to be verified in daily practice.

Factors influencing perception of oral health among adolescents in Sri Lanka.

AIM: To determine factors associated with perceived oral health status among adolescents in Sri Lanka. DESIGN: A descriptive, cross-sectional study where the data were collected by means of an oral examination and questionnaires to both children and their parents. SETTING: Schools in the Colombo district, Sri Lanka. PARTICIPANTS: 1,218, 15-year-old adolescents who were selected from 48 schools using a stratified cluster sampling techniques. RESULTS: Nearly 21% of the sample rated their oral health as poor. According to the hierarchical logistic regression models the percentage of variance in perceived oral health explained by the four groups of independent variables namely: socio-demographic variables, oral health behaviours, clinical oral health indicators and subjective measures of oral health status were 3, 1, 4 and 7% respectively. The final model indicated that poor perceived oral health was significantly associated with low household income, not using dental services, presence of gingivitis, being aware about the presence of oral disease, presence of toothache and other oral symptoms and perceived need for dental care. It accounted for 15% of the variation in perceived oral health. CONCLUSIONS: Subjective measures of oral health contributed most to the single-item perceived oral health rating of adolescents. Socio-demographic variables and normative measures of untreated caries, missing teeth and gingivitis had a limited role in explaining perceived oral health in Sri Lankan adolescents.

An investigation into differential diagnosis of pulp and periapical pain: a PennEndo database study.

Nine hundred fifty-one emergency and 997 nonemergency patients seeking endodontic treatment were the basis of this study. Variables of interest were 10 pain descriptors, percussion and palpation tests, causative factors, and paired pulpal and periapical diagnoses. A higher number of patients suffering from symptomatic pulpal conditions sought emergency care. Odds of caries being a causative factor were high in symptomatic pulps compared with asymptomatic pulpal and periapical conditions. Higher odds ratios were obtained for sharp pain in symptomatic pulps versus symptomatic periapical conditions. Conversely, odds ratios for dull pain were higher in symptomatic periapical conditions compared with asymptomatic periapical conditions. Percussion and palpation tests were significant in differentially diagnosing between pulpal and periapical conditions. In conclusion, caries was associated with painful pulpitis. The results confirm the differential diagnostic power of sharp and dull pain and percussion and palpation tests. Several symptoms previously believed to have differential diagnostic power were found insignificant.

Orofacial pain conditions and impact on quality of life in community-dwelling elderly people in Hong Kong.

AIMS: To determine orofacial pain (OFP) characteristics, associated disability, and effect on quality of life in elderly community-dwelling Chinese people. METHODS: A cross-sectional survey involving elderly people registered with the Family Medicine Unit of the University of Hong Kong served as the sampling frame. Elderly people with recent OFP symptoms and a comparison control group without OFP participated. Standard questions were asked about OFP conditions in the previous month and the Oral Health Impact Profile (OHIP-14), General Health Questionnaire (GHQ-12), and pain-related disability questions were administered prior to a standard clinical examination. RESULTS: Ninety-five people with OFP and 100 people without OFP participated. The median number of pain symptoms per subject was 2.0. Toothache was the most common symptom (58.9%); shooting pain across the face and muscle tenderness were the least common (6.3%). More than half of the pain participants described moderate to severe OFP. The prevalences of patients with neurological/vascular (NV), musculoligamentous/soft tissue (MST), or dentoalveolar (DA) OFP were 35.8%, 33.7%, and 30.5%, respectively. Chronic OFP was common (80%). The mean OHIP-14 summary score was significantly higher in OFP subjects than controls (P < .001) and significantly higher in the MST and DA subgroups than in the NV subgroup (P < .001). GHQ scores of > or = 4, indicating greater psychological distress, were more common in OFP subjects than controls (P < .01). Twenty percent of OFP subjects indicated that their conditions interfered with daily life activities, and in 9.9% it affected ability to work. CONCLUSION: OFP had a substantial detrimental impact on daily life activities, psychological distress level, and quality of life in Chinese elders. MST and DA conditions had the greatest adverse impact on quality of life.

Evaluation of toothache severity in children using a visual analogue scale of faces.

PURPOSE: Pain is a frequent symptom of oral disease. It is difficult to measure, however, due to its subjectivity, especially among children. The purpose of this study was to verify the utility and applicability of a visual analogue scale of faces (VASOF), adapted for 8- to 9-year-olds, to measure the severity of toothaches. METHODS: A cross-sectional study was undertaken, which included 601 boys and girls randomly selected from state and private schools in the city of Belo Horizonte, Minas Gerais, Brazil. They were interviewed and clinically examined, and a VASOF was applied. RESULTS: The VASOF's application revealed a high percentage of intense/very intense pain in the sample (39%). The presence of this pain intensity was accompanied by a high incidence of children who cried, were awakened by the pain, and were unable to carry out habitual tasks. Furthermore, this severe pain was strongly associated with less-privileged economic groups and the presence of oral pathology (P< or =.05). The scale was well understood by children, independent of gender or economic group. CONCLUSIONS: A VASOF was found to be capable of measuring toothache severity experienced by school-age children.

A Medicaid population's use of physicians' offices for dental problems.

OBJECTIVES: This study evaluated how the elimination of Medicaid reimbursement to dentists for the treatment of adult dental problems affected patients' visits to physicians. METHODS: Data tapes describing physicians' claims for adult Medicaid patients were obtained from the Maryland Medicaid Management Information System. The database contains information on all claims made to Maryland Medicaid, including date, provider, International Classification of Diseases, Ninth Revision, Clinical Modification Manual code, and payments. RESULTS: A total of 5334 individuals made physician's office claims related to dental problems sometime during the 4-year study period. The rate of dental-related claims by physicians decreased by 8% after the policy change. CONCLUSIONS: Visits to physicians' offices decreased even though an increase might have been expected because of the elimination of access to dentists in private practice. Patients might have assumed that if visits to dentists would no longer be paid for, neither would visits to physicians' offices.