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781. Articaine for supplemental intraosseous anesthesia in patients with irreversible pulpitis. (PubMed)

Articaine for supplemental intraosseous anesthesia in patients with irreversible pulpitis. The purpose of this study was to determine the anesthetic efficacy and heart rate effect of 4% articaine with 1:100,000 epinephrine for supplemental intraosseous injection in mandibular posterior teeth diagnosed with irreversible pulpitis. Thirty-seven emergency patients, diagnosed with irreversible pulpitis of a mandibular posterior tooth, received an inferior alveolar nerve block and had moderate (...) to provide profound pulpal anesthesia, the intraosseous injection of 4% articaine with 1:100,000 epinephrine would be successful 86% of the time in achieving pulpal anesthesia in mandibular posterior teeth of patients presenting with irreversible pulpitis.

2006 Journal of Endodontics

782. Relationships between caries bacteria, host responses, and clinical signs and symptoms of pulpitis. (PubMed)

Relationships between caries bacteria, host responses, and clinical signs and symptoms of pulpitis. Knowledge of caries bacteria and the inflammatory responses they elicit in the dental pulp is prerequisite to our understanding of the pathogenesis of pulpitis. Recent advances in immunology and neurophysiology can now explain some of the clinical manifestations of pulpitis. The purpose of this review is twofold. The first purpose is to review the literature of the caries microflora, the host (...) immune responses they elicit, and how they do so. The relationship between both proinflammatory and anti-inflammatory cytokines and pulpitis is discussed. The proinflammatory properties of lipoteichoic acid, which is a common virulence factor among Gram-positive bacteria such as those found among the caries bacteria, are reviewed. The second purpose is to review how bacteria and their metabolites, as well as pulpal immune and inflammatory reactions to them, modify the pain sensation in pulpitis.

2007 Journal of Endodontics

783. Tissue levels of immunoreactive substance P are increased in patients with irreversible pulpitis. (PubMed)

Tissue levels of immunoreactive substance P are increased in patients with irreversible pulpitis. Odontogenic pain often involves inflammation of dental pulp tissue. Dental pulp is highly innervated with a subpopulation of sensory neurons containing neuropeptides. Substance P, released from afferent fibers (e.g. nociceptors) is associated with the development of neurogenic inflammation. In this study, we tested the hypothesis that irreversible pulpitis is associated with increased activity (...) of peptidergic neurons, as measured by increased pulpal levels of immunoreactive substance P (iSP). We determined in vivo pulpal levels of immunoreactive substance P in human teeth with a diagnosis of normal pulp or irreversible pulpitis using CMA/20 microdialysis probes inserted into vital pulps of 24 teeth from 21 patients. Probes were perfused with a modified Locke-Ringer's buffer and immunoreactive substance P levels in the dialysate were measured using a radioimmunoassay. Mean extracellular levels

2003 Journal of Endodontics

784. Expression of calcitonin gene-related peptide (CGRP) in irreversible acute pulpitis. (PubMed)

Expression of calcitonin gene-related peptide (CGRP) in irreversible acute pulpitis. The main goal of this study was to evaluate tissue levels of calcitonin gene-related peptide (CGRP) in human pulpal samples collected from teeth with a clinical diagnosis of acute irreversible pulpitis, normal pulps, and teeth with induced pulpal inflammation. All the pulp tissue was mechanically separated, collagenase digested to release individual cells, and labeled with FITC detection of an anti-CGRP (...) pulps and pulps with acute irreversible pulpitis. No significant statistical differences were found between pulps with induced inflammation and pulps with acute irreversible pulpitis. These findings support the hypothesis that the CGRP system is active in human pulpal inflammation and may modulate the inflammatory response.

2004 Journal of Endodontics

785. Anesthetic efficacy of the supplemental X-tip intraosseous injection in patients with irreversible pulpitis. (PubMed)

Anesthetic efficacy of the supplemental X-tip intraosseous injection in patients with irreversible pulpitis. The purpose of this study was to determine the anesthetic efficacy of the supplemental intraosseous injection, using the X-tip system in an apical location, in mandibular posterior teeth diagnosed with irreversible pulpitis when the conventional inferior alveolar nerve block failed. Thirty-three emergency patients, diagnosed with irreversible pulpitis of a mandibular posterior tooth (...) pulpitis.

2003 Journal of Endodontics

786. Effect of NOS inhibitor on cytokine and COX2 expression in rat pulpitis. (PubMed)

Effect of NOS inhibitor on cytokine and COX2 expression in rat pulpitis. Various kinds of chemical mediators are synthesized in the course of pulpitis; thus, control of their production would assist in inducing a reduction in pulpal inflammation. We hypothesized that nitric oxide (NO) would be an important mediator of pulpal inflammation. Pulpal inflammation was induced by the application of LPS in rat incisor pulp, and inducible nitric oxide synthase (iNOS) expression was evaluated by reverse (...) -transcription/polymerase chain-reaction and immunohistochemical staining. After LPS application, iNOS mRNA was first detected after 3 hrs, peaked at 6 hrs, and decreased thereafter. iNOS-positive cells were macrophages and neutrophils. An NOS inhibitor caused drastic decreases in the expression of pro-inflammatory cytokines and COX2 mRNA, which was highly induced in the LPS-induced pulpitis. These results indicate that NO synthesis is related to the initiation of mediator production, and that its down

2005 Journal of Dental Research

787. Measurement of mechanical allodynia and local anesthetic efficacy in patients with irreversible pulpitis and acute periradicular periodontitis. (PubMed)

Measurement of mechanical allodynia and local anesthetic efficacy in patients with irreversible pulpitis and acute periradicular periodontitis. An essential feature of symptomatic periradicular inflammation is mechanical allodynia, defined as reduced mechanical pain thresholds. A previous study evaluating a new digital force transducer showed that it reliably measures mechanical pain thresholds of teeth with normal periradicular tissues. In this study, we tested the hypothesis that the force (...) transducer quantitatively measures mechanical allodynia in teeth with acute periradicular periodontitis (APP) and detects the effects of local anesthetic injection. Mechanical pain thresholds were measured in patients (n = 30) with irreversible pulpitis (IP) and APP and compared with their contralateral teeth. The results show that the mechanical pain thresholds of teeth with IP and APP were reduced by 77% compared with contralateral control teeth. The administration of local anesthesia reversed

2007 Journal of Endodontics

788. TRPM8 Axonal expression is decreased in painful human teeth with irreversible pulpitis and cold hyperalgesia. (PubMed)

TRPM8 Axonal expression is decreased in painful human teeth with irreversible pulpitis and cold hyperalgesia. Pulpitis pain might be triggered by a cold stimulus, yet the cellular mechanisms responsible for this phenomenon are largely unknown. One possible mechanism involves the direct activation of cold-responsive thermoreceptors. The purpose of this study was to evaluate the possible role of the TRPM8 thermoreceptor in cold-mediated noxious pulpal pain mechanisms by comparing expression (...) patterns in pulpal nerves from healthy control molars to cold-sensitive painful molars with irreversible pulpitis. Samples were identically processed with the indirect immunofluorescence method, and images were obtained with confocal microscopy. The immunofluorescence intensity and area occupied by TRPM8 within N52/PGP9.5-identified nerve fibers were quantified. Results showed that relative to normal samples, TRPM8 nerve area expression was significantly less in the cold-sensitive painful samples (34.9

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2007 Journal of Endodontics

789. A six year evaluation of cracked teeth diagnosed with reversible pulpitis: treatment and prognosis. (PubMed)

A six year evaluation of cracked teeth diagnosed with reversible pulpitis: treatment and prognosis. The purpose of this investigation was to report on the clinical outcomes of cracked teeth diagnosed with reversible pulpitis (RP). Eight thousand one hundred seventy-five patients referred for evaluation and treatment during a 6-year period had medical and dental histories, radiographs, pulpal and periapical diagnosis, periodontal probings, direct identification of crack(s) with transillumination (...) diagnosed with RP, 27 converted to irreversible pulpitis (N = 21) in 58 days or to necrotic pulp (N = 6) in 149 days. To date, none of the original remaining 100 cases of RP have required root canal treatment. The outcomes of this study suggest that if a marginal ridge crack is identified early enough in teeth with a diagnosis of RP and a crown is placed, root canal treatment will be necessary in about 20% of these cases within a 6-month period.

2007 Journal of Endodontics

790. The incidence of mechanical allodynia in patients with irreversible pulpitis. (PubMed)

The incidence of mechanical allodynia in patients with irreversible pulpitis. The mechanisms of odontogenic pain are complex and incompletely understood. Cases of irreversible pulpitis are thought to represent a localized inflammatory response to bacterial challenge in dental pulp tissue. The presenting symptoms are classically defined by exaggerated painful episodes to thermal stimuli that may linger after cessation of the stimulus. However, the associated incidence of mechanical allodynia (...) , defined as reduced mechanical pain threshold to masticatory forces, has not been characterized. This study evaluated pain intensity ratings and the presence of mechanical allodynia reported by 993 consecutive dental patients presenting for tooth extraction in a community health center. After clinical and radiographic examinations, the pulpal/periradicular diagnostic categories were normal pulp/normal periradicular (n=792 patients), irreversible pulpitis/normal periradicular (n=86), or irreversible

2007 Journal of Endodontics

791. Effect of an intraosseous injection of depo-medrol on pulpal concentrations of PGE2 and IL-8 in untreated irreversible pulpitis. (PubMed)

Effect of an intraosseous injection of depo-medrol on pulpal concentrations of PGE2 and IL-8 in untreated irreversible pulpitis. The purpose of this prospective, randomized, double-blind study was to evaluate the pulpal concentrations of prostaglandin E2 (PGE2) and interleukin-8 (IL-8) in untreated teeth with irreversible pulpitis after the administration of an intraosseous injection of Depo-Medrol. Forty emergency patients with a clinical diagnosis of irreversible pulpitis experiencing

2003 Journal of Endodontics Controlled trial quality: uncertain

792. The significance of needle deflection in success of the inferior alveolar nerve block in patients with irreversible pulpitis. (PubMed)

The significance of needle deflection in success of the inferior alveolar nerve block in patients with irreversible pulpitis. The purpose of this prospective, randomized, blinded study was to compare the anesthetic efficacy of the conventional inferior alveolar nerve block, administered with the needle bevel oriented away from the mandibular ramus, to the bidirectional-needle-rotation technique, administered using the computer-assisted Wand II anesthesia system, in patients diagnosed (...) with irreversible pulpitis. Sixty-four emergency patients diagnosed with irreversible pulpitis of a mandibular posterior tooth randomly received, in a blinded manner, 2.8 ml of 2% lidocaine with 1:100,000 epinephrine using either a conventional inferior alveolar nerve block or a bidirectional-needle-rotational technique using the Wand II injection system. The conventional inferior alveolar nerve block was administered with the needle bevel oriented away from the mandibular ramus so the needle would deflect

2003 Journal of Endodontics Controlled trial quality: uncertain

793. Anesthetic efficacy of articaine for inferior alveolar nerve blocks in patients with irreversible pulpitis. (PubMed)

Anesthetic efficacy of articaine for inferior alveolar nerve blocks in patients with irreversible pulpitis. The purpose of this prospective, randomized, double-blind study was to compare the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine to 2% lidocaine with 1:100,000 epinephrine for inferior alveolar nerve blocks in patients experiencing irreversible pulpitis in mandibular posterior teeth. Seventy-two emergency patients diagnosed with irreversible pulpitis of a mandibular (...) nerve block using articaine was 24% and for the lidocaine solution success was 23%. There was no significant difference (p = 0.89) between the articaine and lidocaine solutions. Neither solution resulted in an acceptable rate of anesthetic success in patients with irreversible pulpitis.

2004 Journal of Endodontics Controlled trial quality: uncertain

794. [Comparison of the effects of three analgesic therapies on odontalgia caused by pulpitis in molars]. (PubMed)

[Comparison of the effects of three analgesic therapies on odontalgia caused by pulpitis in molars]. To compare the effects of analgesic therapies on odontalgia caused by pulpitis in molars by three different methods.173 molars were diagnosed as irreversible pulpitis, and randomized block designed in three groups. Under block or local anesthesia: 46 cases of the first group, leaving teeth on open drainage, after 1 day, sealing devitalized material (arsenic), arranged next appointment 2 weeks (...) test.The rate of complete analgesia was 50.0%, 63.46% and 76.0%, respectively. There was a significant difference in complete analgesia among the three methods. The analgesic effect of the third group (pulpectomy) was significantly higher than that of the first group (P<0.01).Pulpectomy group had impossibility of adverse effects caused by using devitalizing material (arsenic).It is worthy to adopt pulpectomy extensively to relieve the pain of molars caused by pulpitis clinically. The course

2004 Shanghai kou qiang yi xue = Shanghai journal of stomatology Controlled trial quality: uncertain

795. Success of an alternative for interim management of irreversible pulpitis. (PubMed)

Success of an alternative for interim management of irreversible pulpitis. Extraction and endodontic therapy are treatment options for irreversible pulpitis. Extraction often is chosen for financial reasons. The authors conducted a study to investigate an alternative interim therapy.The authors recruited patients (N = 73) with irreversible pulpitis and whose teeth were restorable but who opted for extraction owing to financial reasons. After undergoing pulpotomy, the teeth were restored

2004 Journal of the American Dental Association Controlled trial quality: uncertain

796. The use of an intra-oral injection of ketorolac in the treatment of irreversible pulpitis. (PubMed)

The use of an intra-oral injection of ketorolac in the treatment of irreversible pulpitis. To examine whether an intra-oral injection of a nonsteroidal anti-inflammatory drug (ketorolac), in association with conventional local anaesthetic techniques, would improve the pulp extirpation rate in teeth with irreversible pulpitis.A two group double-blind clinical trial was undertaken in the Dental Casualty Department of the University of Manchester School of Dentistry. Patients were randomly (...) to 24 h.An intra-oral injection of ketorolac did not improve the pulp extirpation rate in a small group of patients with irreversible pulpitis compared with a placebo. In addition, it was associated with such significant pain on injection that it cannot be recommended as a treatment in this situation.

2005 International endodontic journal Controlled trial quality: uncertain

797. Anesthetic efficacy of lidocaine/meperidine for inferior alveolar nerve blocks in patients with irreversible pulpitis. (PubMed)

Anesthetic efficacy of lidocaine/meperidine for inferior alveolar nerve blocks in patients with irreversible pulpitis. The purpose of this prospective, randomized, single-blind study was to compare the anesthetic efficacy of lidocaine with epinephrine to lidocaine plus meperidine with epinephrine for inferior alveolar nerve blocks (IAN) in patients with mandibular posterior teeth experiencing irreversible pulpitis. Forty-eight emergency patients diagnosed with irreversible pulpitis (...) instrumentation. The success rate for the inferior alveolar nerve block using the lidocaine solution was 26%, and for the lidocaine/meperidine solution, the success rate was 12%. There was no significant difference (p = 0.28) between the two solutions. In conclusion, for mandibular posterior teeth with irreversible pulpitis, the addition of 36 mg of meperidine to a lidocaine solution administered in a conventional IAN block did not improve the success rate over a standard lidocaine solution.

2007 Journal of Endodontics Controlled trial quality: uncertain

798. The effect of preoperative acetaminophen or a combination of acetaminophen and Ibuprofen on the success of inferior alveolar nerve block for teeth with irreversible pulpitis. (PubMed)

The effect of preoperative acetaminophen or a combination of acetaminophen and Ibuprofen on the success of inferior alveolar nerve block for teeth with irreversible pulpitis. This study compared preoperative administration of acetaminophen or a combination of acetaminophen and ibuprofen versus placebo for potential increased effectiveness of inferior alveolar nerve (IAN) block anesthesia. There were 40 patients with irreversible pulpitis randomly assigned to a drug or placebo group. Thirty

2007 Journal of Endodontics Controlled trial quality: uncertain

799. A double-blind comparison of a supplemental interligamentary injection of fentanyl and mepivacaine with 1:200,000 epinephrine for irreversible pulpitis. (PubMed)

A double-blind comparison of a supplemental interligamentary injection of fentanyl and mepivacaine with 1:200,000 epinephrine for irreversible pulpitis. The analgesic efficacy of supplemental interligamentary fentanyl injection for management of endodontic debridement patients was investigated through a randomized, double-blind study. Forty patients who presented with acute symptomatic irreversible pulpitis of the upper first molar tooth participated in the study. Patients were scheduled

2007 Journal of pain and symptom management Controlled trial quality: uncertain

800. Use of verbal descriptors, thermal scores and electrical pulp testing as predictors of tooth pain before and after application of benzocaine gels into cavities of teeth with pulpitis. (PubMed)

Use of verbal descriptors, thermal scores and electrical pulp testing as predictors of tooth pain before and after application of benzocaine gels into cavities of teeth with pulpitis. A double-blind pilot study was conducted on 27 consenting human volunteers who had irreversible pulpitis associated with persistent toothache pain from open carious lesions. Formulations tested contained either 0, 10%, or 20% benzocaine and were identified only by a numbered code. Before the experiment started (...) out of 18 improved) compared to placebo (3 out of 9 improved). It was concluded that: 1) benzocaine gels are effective formulations for temporary relief of toothache pain, 2) there were no statistical differences in EPT scores between teeth having pulpitis and control teeth, 3) there were no correlations between direction of EPT scores and pain relief, 4) cold water testing was a good predictor of whether or not a tooth had pulpitis, and 5) changes in cold water testing scores after treatment

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1991 Anesthesia progress

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