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The reported prevalence of DH?
DI reported to have higher incidence in ______. Peak reported period is the ___ to _____ decades of life.
The locations most often affected by DH tend to be the ________ region of _______ and ________, often the side __________ the dominant hand.
Application of which materials block the fluid flow of tubules reducing symptoms of DI?
- Gluma Dentin Bond (Heraeus Kulzer)
- oxalate salts
- isobutyl cyanoacrylate
- fluoride releasing resins or varnishes
- CO2 LASERs
- Burnishing dentin
What ingredient in dentrifices has been found to be effective in reducing neuronal activity during DH?
73% of formulations were significantly better
- 3.75% KNO3 60.8% reduction
- 5% " " 61.2% reduction
What other formulations have been shown to reduce DH?
10% strontium chloride, 72.5% reduction
Guanethidine 1% solution 50% reduction
How does guanethidine work to reduce DH?
inhibits exocytosis from peripheral terminals of sympathetic fibers
blocks sympathetically regulated blood flow in dental pulp
directly alters nociceptors, Adelta fibers and C-fibers
What is the 3D method of pain control?
Who determined 88% reduction in pain after pulpotomy due to IP regardless of coronal medicment?
Pulpotomies are performed for which cases? Pulpectomies?
Vital cases (pain of pulpal origin)
Nonvital (pulpal and periradicular origin)
Pulpotomies are more effective in relieiving pain.
Occlusal adjustment is a definitive treatment for which cases?
Vital pulps with percussion sensitivity, Rosenberg.
The pain relieving benefits of definitive dental treatment are attributed to?
1. reduced tissue levels of factors that stimulate peripheral terminals of nociceptors
2. reduction of mechanical stimulation of sensitized nociceptors (occlusal adj)
Three primary pharmacologic approaches to pain control?
1. blocking inflammatory mediators that sensitize or activate pulpal nociceptors
2. drugs that block the propagation of impulses along peripheral nerves
3. drugs that block central mechanisms of pain perception and hyperalgesia
Acute surgery-induced inflammation is mediated by releases of? Compare to pulpal pain?
Eicosanoids (Prostacyclin, prostaglandin E2)
Pulpal pain is attributed to bacterial by-products, immune cells, cytokines
Endodontic pain control studies show which NSAIDs to be effective?
What is the floor effect?
A statistical concept where it is difficult to distinguish between two interventions when both produce results near the minimal point of measurement.
Essentially treatment with pulpectomy already reduces patients pain levels and adding drugs may not show the true effect of analgesia unless the patient came in preoperatively with moderate to sever pain.
What is the benefit of NSAIDs have high plasma affinity?
better distribution in inflammatory tissue due to vasodilation and plasma extravasation.
Which COX isoform is found in inflamed pulp tissues?
Celecoxib is what kind of drug?
Selective COX-2 inhibitor, Celebrex
caution in patient with GI conditions, causes inc risk of GI irritation.
Which patients should avoid NSAID use?
Those with medications like Aspirin, steroid, warfarin use
OR prev hx of ulcer hemorrhage, pt over 65
What is Vimovo?
Combined PPI (esomeprazole and Naproxen) to reduce risk of GI bleeding
What is Duexis?
Combined H2 antagonist with NSAID, famotidene with ibuprofen.
How do glucocorticoids work to reduce pain?
Suppress vasodilation, neutrophil migration, phagocytosis
Inhibit formation of arachidonic acid from neutrophil and macrophage cell membrane phospholipids
Block COX and Lipoxygenase pathways to reduce prostaglandins and leukotrienes
Name some long acting anesthetics?
Etidocaine or bupivicaine
What is the pre-emptive analgesia hypothesis?
Clinical pain is reduced when the peripheral barrage of nociceptors is reduced
Factors that affect the success of local anesthesia include?
Speed of injection
Route of admin
Presence of inflammation
What increases the activity of TTX resistant sodium channels?
PGE2, nerve growth factor, and serotonin
Channels are 1/4 as sensitive to lidocaine
What side effect is common to lido with epi?
4 minute transient tachycardia, avg inc of 28bpm
4% articaine was avg of 32bpm
Intraosseous success rates of various anesthetics?
Lido 2% w/epi 74%
3% mepivicaine 45% (higher with second dose)
4% articaine w/epi 86%
Who found that a second injection of lido 2% w/epi increased success of pulpal anesthesia in IP to 91%?
When used for mandibular block anesthesia, _______ was superior to lidocaine only in _____________ or normal teeth, but not in _____________ teeth.
Articaine works great as a local infiltrate, not any better with IAN blocks.
How many patients reported moderate to sever pain the day after receiving PDL injection?
What is the prototype opioid drug?
Codeine, acts on mu receptors, usually 60mg
What is pentazocine?
Mixed agonist-antagonist opioid
acts on kappa (agonist) and partial agonist on delta opioid receptors. Mixed on mu.
Combination of it and naloxone .5mg has been shown effective in females.
Who showed that the 16.76% endodontists who prescribe antibiotics to relieve pain (IP) are wrong?
Nagle, showed no effect
What percent of patients will have mod to sev post endodontic pain?
20%, 80% will be none to slight