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1.
  • Alkhateeb, Noor, et al. (författare)
  • Patient-perceived features and clinical characteristics of tooth pain : A comparison between apical periodontitis and persistent dento-alveolar pain disorder (PDAP) – preliminary results
  • 2017
  • Konferensbidrag (övrigt vetenskapligt)abstract
    • Background: Differential diagnosis between tooth pain of inflammatory and neuropathic origin is crucial since treatment strategies differ. Aim: Evaluate and compare self-reported and clinically observed pain characteristics in patients with SAP (symptomatic apical periodontitis) and PDAP (persistent dento-alveolar pain disorder). Methodology: Patients diagnosed with SAP and PDAP were recruited from Malmö University and Folktandvården Östergötland. Data collection included clinical examination and questionnaire (tooth pain characteristics, verbal pain description [short-form McGill Pain Questionnaire; SF-MPQ], factors affecting the pain). Results: Data from 24 patients with SAP and 20 with PDAP (24 females, mean age 53 years) were analyzed. Average pain intensity was 4.4 (0–10 numeric rating scale) and average duration 1527 days. 64% reported continuous and 27% recurrent pain. 58% of teeth were tender to percussion and 66% to apical palpation. 27% reported concurrent pain from jaw muscles/joints. Significant differences were found for gender (% females; PDAP>SAP;p=0.013), pain duration (PDAP>SAP;p<0.0001), pain frequency (PDAP>SAP;p<0.001), percussion tenderness (SAP>PDAP;p=0.012), muscle/joint pain (PDAP>SAP;p=0.021). SF-MPQ and affecting factors did not differ (p=0.096–1.000). Conclusion: Preliminary results indicate that pain intensity, pain description and factors affecting the pain are similar for SAP and PDAP. Female gender, long pain duration, high pain frequency, and concurrent muscle/joint pain presented more frequently in PDAP.
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2.
  • Baad-Hansen, Lene, et al. (författare)
  • Chairside intraoral qualitative somatosensory testing: reliability and comparison between patients with atypical odontalgia and healthy controls
  • 2013
  • Ingår i: Journal of Orofacial Pain. - Quintessence. - 1064-6655. ; 27:2, s. 165-170
  • Tidskriftsartikel (refereegranskat)abstract
    • AIMS: To assess intraoral inter- and intraexaminer reliability of three qualitative measures of intraoral somatosensory function and to compare these measures between patients with atypical odontalgia (AO) and healthy controls. METHODS: Thirty-one AO patients and 47 healthy controls participated. Inter- and intraexaminer reliability was tested on a subgroup of 46 subjects (25 AO; 21 healthy). Sensitivity to touch, cold, and pinprick stimuli was evaluated on the painful gingival site and the corresponding contralateral site in AO patients, and bilaterally on the gingiva of the first maxillary premolars in controls. Patients were asked to report hypersensitivity, hyposensitivity, or normal sensitivity to stimuli on the painful site compared with the nonpainful site. Kappa values were calculated, and chi-square and Fisher's exact tests were used to compare frequencies between groups. RESULTS: Kappa values ranged between 0.63 and 0.75. The frequency of hypersensitivity to either modality was significantly higher in patients (29% to 61%) than in controls (9% to 17%) (P < .015), whereas reports of hyposensitivity were similar between groups (2% to 16%) (P > .057). Only 3.2% of the AO patients had no reports of abnormal sensitivity on any of the tests, compared with 59.6% of the healthy subjects (P < .001). CONCLUSION: Intraoral qualitative somatosensory testing can detect intraoral sensory disturbances in AO patients, and the reliability is sufficient for initial screening of orofacial somatosensory function.
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3.
  • Baad-Hansen, Lene, et al. (författare)
  • Intraoral somatosensory abnormalities in patients with atypical odontalgia : a controlled multicenter quantitative sensory testing study
  • 2013
  • Ingår i: Pain. - Elsevier. - 0304-3959. ; 154:8
  • Tidskriftsartikel (refereegranskat)abstract
    • Intraoral somatosensory sensitivity in patients with atypical odontalgia (AO) has not been investigated systematically according to the most recent guidelines. The aims of this study were to examine intraoral somatosensory disturbances in AO patients using healthy subjects as reference, and to evaluate the percent agreement between intraoral quantitative sensory testing (QST) and qualitative sensory testing (QualST). Forty-seven AO patients and 69 healthy control subjects were included at Universities of Washington, Malmö, and Aarhus. In AO patients, intraoral somatosensory testing was performed on the painful site, the corresponding contralateral site, and at thenar. In healthy subjects, intraoral somatosensory testing was performed bilaterally on the upper premolar gingiva and at thenar. Thirteen QST and 3 QualST parameters were evaluated at each site, z-scores were computed for AO patients based on the healthy reference material, and LossGain scores were created. Compared with control subjects, 87.3% of AO patients had QST abnormalities. The most frequent somatosensory abnormalities in AO patients were somatosensory gain with regard to painful mechanical and cold stimuli and somatosensory loss with regard to cold detection and mechanical detection. The most frequent LossGain code was L0G2 (no somatosensory loss with gain of mechanical somatosensory function) (31.9% of AO patients). Percent agreement between corresponding QST and QualST measures of thermal and mechanical sensitivity ranged between 55.6% and 70.4% in AO patients and between 71.1% and 92.1% in control subjects. In conclusion, intraoral somatosensory abnormalities were commonly detected in AO patients, and agreement between quantitative and qualitative sensory testing was good to excellent.
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4.
  • Drangsholt, Mark, et al. (författare)
  • Quantitative Sensory Testing of Chronic Continuous Dentoalveolar Pain
  • 2010
  • Annan publikation (populärvet., debatt m.m.)abstract
    • Objectives: Chronic continuous dentoalveolar pain (CCDAP) is a new term for chronic pain around teeth. Quantitative sensory testing (QST) has shown promise as a tool for studying mechanisms of pain conditions. Aims: 1) compare sensory parameter values in CCDAP patients and symptom-free controls; and 2) characterize the somatosensory profile of patients with CCDAP. Methods: The German Neuropathic Pain QST protocol of 13 somatosensory function tests was adapted for intraoral use. Cases with CCDAP from tertiary care clinics were tested along with symptom-free controls. QST was performed intra-orally on symptomatic facial gingiva, asymptomatic contralateral site, and non-trigeminal site (thumb). Means and standard deviations were compared between symptomatic and asymptomatic sites within cases and with controls. Results: Interim analyses of 17 controls and 13 cases showed a mean age of 37 years for controls and 55 for cases. At the thumb, significant differences (p < 0.05) between cases/controls were apparent for pressure pain threshold (PPT) 353 vs. 453 kPa; mechanical pain threshold (MPT) 75 vs. 161 mN; and cold pain threshold (CPT) 8.4 vs. 2.8 C, all showing cases more sensitive. At the painful gingival site, significant differences between cases/controls existed for: CPT 17.4 vs. 8.1 C; HPT 44 vs. 49 C; MPT 55 vs. 154 mN; and PPT 106 vs. 172 kPa. Non-painful parameters, such as cold and warm detection threshold were generally not significantly different between cases/controls at thumb and painful gingival sites. Among cases only, comparing painful to nonpainful side, MPT was 55 vs. 96 mN; mechanical pain sensitivity 4.7 vs. 3.0; PPT 106 vs. 122 kPa, all more sensitive on the painful site. Conclusions: These results suggest that CCDAP patients are more sensitive to multiple modalities of painful stimulation at both non-trigeminal and trigeminal sites, and may be exhibiting a trigeminal neuropathy with gain in function. Grant: NIHR21DE018768.
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5.
  • Engfalk, Paul, et al. (författare)
  • Influence of intra- and extraoral sites and size of stimulation area on thermal detection and pain threholds. A methodological study
  • 2007
  • Ingår i: Swedish Dental Journal. - 0347-9994. ; 31:4
  • Annan publikation (populärvet., debatt m.m.)abstract
    • Aim: This study compared cool detection thresholds, warm detection thresholds and heat pain thresholds at intra- and extraoral locations and measured the influence of spatial summation. Material and Methods: Thirty healthy individuals (15 females and 15 males), mean age 24.9 years, range 20-31 years) participated in the study. Thresholds for warm detection (WDT), cool detection (CDT) and heat pain threshold (HPT) were measured using a thermotester (MSA–Modular sensory Analyzer, Somedic). The intraoral thermode was custom-made with a 9x9mm square surface. The average of three measurements was recorded. Four intraoral sites (gingival regions 24 and 34, tip of the tongue, lower lip) and two extraoral sites (infraorbitalis, thenar) were measured in each participant. To measure spatial summation, five acrylic covers (tip areas: 0.81 cm2, 0.50 cm2, 0.28cm2, 0.125cm2, 0 cm2) were made to fit the thermode. Five measurements on the tip of the tongue were averaged for each acrylic cover. Results: Of the extraoral sites, the cold detection threshold was significantly higher and the heat pain threshold was significantly lower at the infraorbitalis than at the thenar. Of the intraoral sites, the cold detection threshold was significantly lower at the tongue than at any of the other intraoral locations; the heat pain threshold was significantly lower on the tip of the tongue than on the lower lip. Warm detection and heat pain thresholds rose slightly with increasing thermode size, and this association was more pronounced than for cold detection thresholds. Conclusion: Temperature thresholds differed significantly between several anatomic sites, and the association between size of stimulation area and temperature thresholds was weak.
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6.
  • Jonsson Sjögren, Jakob, et al. (författare)
  • Pain and discomfort from root-filled teeth : Aspects of prevalence and characteristics
  • 2017
  • Ingår i: International endodontic journal. - Wiley. - 1365-2591. ; 50:S 1
  • Konferensbidrag (övrigt vetenskapligt)abstract
    • Aim The aim was to examine the prevalence and characteristics of pain and discomfort from root-filled teeth in an adult Swedish population regularly attending dental care. A further aim was to examine if symptoms could be related to (i) periapical radiographic appearance and (ii) clinical findings. Methodology This cross-sectional observational study screened all adult patients scheduled for routine check-up in the public dental service, Örebro County, Sweden in April 2015. All (798) individuals with at least one root-filled tooth were asked to participate. The examination included (i) clinical examination, (ii) radiographic examination (intraoral periapical images), (iii) interviewer-assisted questionnaire covering general health and presence and characteristics of pain. Descriptive statistics were performed and Fisher’s exact test analysed correlations. Results 549 patients with 1256 root-filled teeth participated (292 women, 257 men; mean age 61.1 years, range 20–94). 55 (10.0%) of the patients experienced pain or discomfort from at least one root-filled tooth. On tooth level, 66 (5.3%) of all root-filled teeth were symptomatic. The average pain intensity was 2.2±1.9 on a 0–10 Numeric Rating Scale, and mean pain duration was 32.6 months. The pain was continuous for 21.3%, recurrent for 44.3%, and occasional for 34.4% of the teeth, and the teeth had been painful on average 9.6 of the last 30 days. Apical radiolucency was recorded at 264 (21.6%) of the root-filled teeth. Symptoms were significantly associated with presence of radiolucency (P=0.004), sinus tract (P=0.023), and pocket depth >5mm (P=0.038). Conclusions In the examined population, one in ten adults with a root-filled tooth experienced pain or discomfort associated with this tooth. The pain was generally of low intensity and long lasting. In most cases, the patient experienced recurrent or occasional pain, but one in five with painful teeth had continuous pain.
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7.
  • Jonsson Sjögren, Jakob, et al. (författare)
  • The Prevalence of Pain and Discomfort from Root-Filled Teeth
  • 2017
  • Konferensbidrag (övrigt vetenskapligt)abstract
    • Objective The aim was to examine the prevalence and characteristics of pain and discomfort from root-filled teeth in an adult Swedish population regularly attending dental care. A further aim was to examine if symptoms could be related to (i) periapical radiographic appearance and (ii) clinical findings. Methods This cross-sectional observational study screened all adult patients scheduled for routine check-up in the public dental service, Örebro County, Sweden in April 2015. All (798) individuals with at least one root-filled tooth were asked to participate. The examination included (i) clinical examination, (ii) radiographic examination (intraoral periapical images), (iii) interviewer-assisted questionnaire covering general health and presence and characteristics of pain. Descriptive statistics and Fisher’s exact test were performed. Results 549 patients with 1256 root-filled teeth participated (292 women, 257 men; mean age 61.1 years, range 20–94). 55 (10.0%) of the patients experienced pain or discomfort from at least one tooth. On tooth level, 66 (5.3%) of all root-filled teeth were symptomatic. The average pain intensity was 2.2±1.9 on a 0–10 Numeric Rating Scale, and mean duration was 32.6 months. The pain was continuous for 21.3%, recurrent for 44.3%, and occasional for 34.4% of the teeth, and the teeth had been painful on average 9.6 of the last 30 days. Apical radiolucency was recorded at 264 (21.6%) of the root-filled teeth. Symptoms were significantly associated with presence of radiolucency (P=0.004), sinus tract (P=0.023), and pocket depth >5mm (P=0.038). Conclusion In the examined population, one in ten adults with a root-filled tooth experienced pain or discomfort associated with this tooth. The pain was generally of low intensity and long lasting. In most cases, the patient experienced recurrent or occasional pain, but one in five had continuous pain.
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8.
  • Mikkilä, Hanna, et al. (författare)
  • A comparison of two different methods to measure pressure pain thresholds : An experimental study
  • 2017
  • Konferensbidrag (övrigt vetenskapligt)abstract
    • Introduction: Assessment of somatosensory function is recommended in orofacial pain investigations. Quantitative Sensory Testing (QST) is a comprehensive method in which pressure pain threshold (PPT) measurement is included. PPT is usually obtained with a conventional Algometer Type II. A new computer-controlled and potentially more user-friendly algometer, the SENSEBox, could replace the conventional device provided that threshold values and other properties are similar between devices. Aim: Compare two algometers regarding absolute PPT, variability, time, and test-retest-reliability. Materials and methods: PPT was measured with both devices on thenar, masseter muscle and gingiva (upper premolar region) in twenty healthy adults. For each anatomic site and device, the mean value of three registrations was calculated. Paired t-test and Wilcoxon sign-rank test compared mean PPT, variability and time duration. Intraclass Correlation Coefficient (ICC) analyzed test-retest reliability. Results: The SENSEBox showed overall lower PPTs (p<0.05). No significant differences in variability and time duration were found (p>0.05). Both devices showed very good to excellent test-retest-reliability (ICC 0.75–0.88) for thenar and masseter. On gingiva, Algometer Type II showed poor (ICC 0.38) and SENSEBox good reliability (ICC 0.43). Conclusion: The Algometer Type II and SENSEBox are not readily interchangeable in PPT assessment and QST in orofacial pain investigations.
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9.
  • Närhi, Matti, et al. (författare)
  • Acute dental pain I : pulpal and dentinal pain
  • 2016
  • Ingår i: Tandlaegebladet. - Tandlaegeforeningen. - 0039-9353. ; 120:2, s. 110-119
  • Tidskriftsartikel (refereegranskat)abstract
    • Den specialiserede anatomi i pulpa-dentin-organet samt den rige pulpale innervation fra trigeminusnerven forklarer de forskellige typer af smertefølelser i en tand. En kort skarp smerte er typisk for en A-(nerve) fibermedieret smerte, imens en langvarig, bankende smerte indikerer C-(nerve) fiberaktivitet. A-fibre reagerer på termiske eller mekaniske stimuli, såsom kolde drikke eller tandbørstning, imens C-fibre hovedsagelig aktiveres ved inflammatoriske mediatorer. Således vil en dvælende smerte indikere en irreversibel pulpal inflammation. Ved pulpitis vil der opstå strukturelle ændringer i de pulpale nerver, der samtidig frigiver neuropeptider, som udløser et immunrespons: neurogen inflammation. Smertefornemmelser under pulpitis kan variere fra hypersensibilitet overfor termiske stimuli til svære dunkende og uudholdelige smerter. Smerterne kan være meddelte og ofte vanskelige at lokalisere, hvorfor diagnostik af inflammation i pulpa er en klinisk udfordring. En biofilm forstærker hypersensitivitet af eksponerede dentinoverflader, fordi de mikrobielle irritamenter kan nå pulpa gennem åbne dentintubuli, hvorved der fremkaldes inflammation. Fjernelse af biofilm reducerer isninger i tænderne, men supplerende behandling er ofte nødvendigt med det formål at opnå en reduktion af dentinens permeabilitet. Cariesekskavering samt fyldningsterapi er en tilstrækkelig behandling ved en klinisk bedømt reversibel pulpitis, hvorimod endodontisk behandling er nødvendigt, når pulpitis har nået et irreversibelt stadium.
10.
  • Olsson, Sara R, et al. (författare)
  • Demographic factors in the choice of coronal restoration after root canal treatment in the Swedish adult population
  • 2017
  • Ingår i: International endodontic journal. - Wiley. - 1365-2591. ; 50:S1
  • Konferensbidrag (övrigt vetenskapligt)abstract
    • Aim: To compare demographic characteristics between individuals choosing an indirect coronal restoration (crown, inlay/onlay) and individuals receiving other restorations after completion of a root filling. The hypothesis was that there are demographic differences for individuals who chose an indirect and those who chose another coronal restoration after root canal treatment. Methodology: This was a registry study of a cohort consisting of all root filled upper first molars that were reported to the tax-funded Swedish Social Insurance Agency (SSIA) during 2009. The root filled teeth were identified by tooth position 16 and 26, and by specific registry codes applied to root fillings. After registration of the root filling, any subsequent coronal restorations within two years was identified. The study group consisted of individuals registered with a root filling followed by an indirect coronal restoration and the control group was the remaining individuals with a root-filled tooth and a direct coronal restoration or no registration of any coronal restoration. Data on nationality, disposable income, educational level, civil status, age and gender were received from Statistics Sweden or SSIA. Chi-square test, t-test and logistic regression compared groups. P<0.05 was considered statistically significant. Results: 7 806 individuals (21.9%) received an indirect coronal restoration and 27 886 individuals (78.1%) comprised the control group. All demographic variables but gender and nationality differed significantly between groups A significantly larger proportion of individuals in the study group had higher education, higher disposable income, were older and were less likely to be living on their own. Conclusions: The identified demographic differences between individuals having their newly root filled teeth restored with an indirect restoration compared to those receiving other restorations indicate that the tax-funded Swedish dental insurance fails to provide dental care on equal terms for Swedish citizens.
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