• The Korean Journal of Pain
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• v.30 no.4
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• pp.258-264
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• 2017

Background: Pulpal pain is one of the most common and severe orofacial pain conditions with considerable adverse effects on physiological processes including learning and memory. Regular exercise is known to be effective on cognitive function as well as pain processing in the central nervous system. Here, the possible effects of regular exercise on pulpal pain response as well as pain-induced changes in learning and memory efficiency in rats were investigated. Methods: Twenty-four male Wistar rats were randomly assigned to the control, capsaicin, exercise, and exercise plus capsaicin groups. Rats in exercise groups were forced to run on a treadmill with a moderate exercise protocol for 4 weeks. Capsaicin was used to induce dental pulp pain. Passive avoidance learning and memory performance was assessed by using a shuttle box apparatus. Results: According to the results, regular exercise could decrease the time course of capsaicin-induced pulpal pain (P < 0.001). Moreover, in capsaicin-treated rats, passive avoidance acquisition was impaired as compared to the control (P < 0.05) and exercise (P < 0.001) groups. Additionally, regular exercise before capsaicin injection could attenuate capsaicin-induced memory impairments (P < 0.05). Conclusions: Taken together, the present data showed that regular exercise has inhibitory effects on capsaicin-induced pulpal pain as well as pain-induced cognitive dysfunction in rats.

• The Korean Journal of Pain
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• v.26 no.4
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• pp.347-355
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• 2013

Pain and pain control are important to the dental profession because the general perception of the public is that dental treatment and pain go hand in hand. Successful dental treatment requires that the source of pain be detected. If the origin of pain is not found, inappropriate dental care and, ultimately, extraction may result. Pain experienced before, during, or after endodontic therapy is a serious concern to both patients and endodontists, and the variability of discomfort presents a challenge in terms of diagnostic methods, endodontic therapy, and endodontic knowledge. This review will help clinicians understand the basic neurophysiology of pulpal pain and other painful conditions of the dental pulp that are not well understood.

• The Korean Journal of Pain
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• v.35 no.3
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• pp.261-270
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• 2022

Background: The rostral ventromedial medulla (RVM) is a critical region for the management of nociception. The RVM is also involved in learning and memory processes due to its relationship with the hippocampus. The purpose of the present study was to investigate the molecular mechanisms behind orexin-A signaling in the RVM and hippocampus's effects on capsaicin-induced pulpal nociception and cognitive impairments in rats. Methods: Capsaicin (100 g) was applied intradentally to male Wistar rats to induce inflammatory pulpal nociception. Orexin-A and an orexin-1 receptor antagonist (SB-334867) were then microinjected into the RVM. Immunoblotting and immunofluorescence staining were used to check the levels of cyclooxygenase-2 (COX-2) and brain-derived neurotrophic factor (BDNF) in the RVM and hippocampus. Results: Interdental capsaicin treatment resulted in nociceptive responses as well as a reduction in spatial learning and memory. Additionally, it resulted in decreased BDNF and increased COX-2 expression levels. Orexin-A administration (50 pmol/1 µL/rat) could reverse such molecular changes. SB-334867 microinjection (80 nM/1 µL/rat) suppressed orexin's effects. Conclusions: Orexin-A signaling in the RVM and hippocampus modulates capsaicin-induced pulpal nociception in male rats by increasing BDNF expression and decreasing COX-2 expression.

• Journal of Dental Anesthesia and Pain Medicine
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• v.19 no.6
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• pp.323-341
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• 2019

Background: Local anesthetics alone or in combination with adjuncts, such as oral medications, have routinely been used for pain control during endodontic treatment. The best clinical choice amongst the vast numbers of agents and techniques available for pain control for irreversible pulpitis is unclear. This network meta-analysis combined the available evidence on agents and techniques for pulpal anesthesia in the maxilla and mandible, in order to identify the best amongst these approaches statistically, as a basis for future clinical trials. Methods: Randomized trials in MEDLINE, DARE, and COCHRANE databases were screened based on inclusion criteria and data were extracted. Heterogeneity was assessed and odds ratios were used to estimate effects. Inconsistencies between direct and indirect pooled estimates were evaluated by H-statistics. The Grading of Recommendation, Assessment, Development, and Evaluation working group approach was used to assess evidence quality. Results: Sixty-two studies (nine studies in the maxilla and 53 studies in the mandible) were included in the meta-analysis. Increased mandibular pulpal anesthesia success was observed on premedication with aceclofenac + paracetamol or supplemental 4% articaine buccal infiltration or ibuprofen+paracetamol premedication, all the above mentioned with 2% lignocaine inferior alveolar nerve block (IANB). No significant difference was noted for any of the agents investigated in terms of the success rate of maxillary pulpal anesthesia. Conclusion: Direct and indirect comparisons indicated that some combinations of IANB with premedication and/or supplemental infiltration had a greater chance of producing successful mandibular pulpal anesthesia. No ideal technique for maxillary anesthesia emerged. Randomized clinical trials with increased sample size may be needed to provide more conclusive data. Our findings suggest that further high-quality studies are required in order to provide definitive direction to clinicians regarding the best agents and techniques to use for mandibular and maxillary anesthesia for irreversible pulpitis.

• Journal of Dental Anesthesia and Pain Medicine
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• v.23 no.3
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• pp.135-141
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• 2023

Background: The limited studies on the effect of buffering on the clinical efficacy of articaine have reported controversial results. The purpose of this study was to clinically compare the pain of injection, anesthetic success, onset, and duration of pulpal anesthesia of buffered 4% articaine with epinephrine 1:100000 versus a non-buffered 4% articaine with epinephrine 1:100000 formulation for buccal infiltration of the mandibular first molar. Methods: Sixty-three volunteers were enrolled in the study. All volunteers received two injections consisting of a single mandibular first molar buccal infiltration with 1.8 ml of 4% articaine with epinephrine 1:100000 and 1.8 ml of 4% articaine with epinephrine 1:100000 buffered with 8.4% sodium bicarbonate. The infiltrations were applied in two separate appointments spaced at least one week apart. After injection of the anesthetic solution at the examined site, the first molar was pulp-tested every 2 min for the next 60 min. Results: Successful pulpal anesthesia was recorded in 69.8% of cases using non-buffered articaine solution and 76.2% of cases using buffered articaine solution, with no significant difference between the formulations (P = 0.219). The mean time of anesthesia onset for the volunteers with successful anesthetic outcome in both formulations (n = 43) was 6.6 ± 1.6 min for the non-buffered articaine solution and 4.5 ± 1.6 min for the buffered solution, which differed significantly (P = 0.001). In the same volunteers, the mean duration of pulpal anesthesia was 28.4 ± 7.1 min for non-buffered articaine solution and 30.2 ± 8.5 min for buffered articaine solution, with no significant difference between the formulations (P = 0.231). Considering the pain of injection, regardless of the anesthetic success, the mean values of VAS were 11.3 ± 8.2 mm for the non-buffered articaine solution and 7.8 ±6.5 mm for the buffered articaine solution, which differed significantly (P = 0.001 < 0.05). Conclusion: According to the present study, 4% articaine with epinephrine can benefit from buffering and provide better anesthetic behavior, with improved onset and less pain during injection.

• Journal of Oral Medicine and Pain
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• v.41 no.2
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• pp.80-84
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• 2016

Non-odontogenic toothaches are frequently present and can be challenge to the dental clinician. A 41-year-old male patient with sharp and spontaneous pain on the right maxillary posterior dentition, which developed as like localized toothache 3 months ago, was finally treated with endoscope assisted sinus surgery on right maxillary sinus. Although the initial clinical characteristics are similar to odontogenic toothache in this patient, previous several treatment with the affected teeth did not alleviate the pain. Sinusitis around the facial structure is one of the common causes to make referred pain to maximally teeth and the sinus toothache resembles the pulpal or the periodontal toothache. The clinician should be well aware of various causes of the non-odontogenic toothache and be able to differentiate them.

• Journal of Oral Medicine and Pain
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• v.41 no.3
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• pp.85-90
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• 2016

Purpose: The aim of this study was to develop an automated software to extract tooth and pulpal area from sectional cone-beam computed tomography (CBCT) images, which can guarantee more reproducible, objective and time-saving way to measure pulp/tooth volume ratio. Methods: The software program was developed using MATLAB (MathWorks). To determine the optimal threshold for the region of interest (ROI) extraction, user interface to adjust the threshold for extraction algorithm was added. Default threshold was determined after several trials to make the outline of extracted ROI fitting to the tooth and pulpal outlines. To test the effect of starting point location selected initially in the pulpal area on the final result, pulp/tooth volume ratio was calculated 5 times with different 5 starting points. Results: Navigation interface is composed of image loading, zoom-in, zoom-out, and move tool. ROI extraction process can be shown by check in the option box. Default threshold is adjusted for the extracted tooth area to cover whole tooth including dentin, cementum, and enamel. Of course, the result can be corrected, if necessary, by the examiner as well as by changing the threshold of density of hard tissue. Extracted tooth and pulp area are reconstructed three-dimensional (3D) and pulp/tooth volume ratio is calculated by voxel counting on reconstructed model. The difference between the pulp/tooth volume ratio results from the 5 different extraction starting points was not significant. Conclusions: In further studies based on a large-scale sample, the most proper threshold to present the most significant relationship between age and pulp/tooth volume ratio and the tooth correlated with age the most will be explored. If the software can be improved to use whole CBCT data set rather than just sectional images and to detect pulp canal in the original 3D images generated by CBCT software itself, it will be more promising in practical uses.

• Journal of Dental Anesthesia and Pain Medicine
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• v.24 no.4
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• pp.265-272
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• 2024

Effective pain management is crucial for the successful performance of various endodontic procedures. Painless treatments are made possible by anesthetizing the tooth to be treated using various nerve-block techniques. However, certain circumstances necessitate supplemental anesthetic techniques to achieve profound anesthesia, especially in situations involving a "hot tooth" in which intrapulpal anesthesia (IPA) is employed. IPA is a technique that involves the injection of an anesthetic solution directly into the pulp tissue and is often utilized as the last resort when all other anesthetic techniques have been unsuccessful in achieving complete pulpal anesthesia. This review focuses on the IPA procedure and the factors that influence its success. Additionally, the advantages, limitations, disadvantages, and future directions of IPA are discussed.

• Journal of Dental Anesthesia and Pain Medicine
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• v.19 no.4
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• pp.201-208
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• 2019

Background: After tooth extraction, pain due to dry socket and pain in the adjacent tooth are common. The aim of this study was to retrospectively analyze pain in the adjacent tooth after surgical extraction of the mandibular third molar. Methods: Postoperative pain due to dry socket, pain in the adjacent tooth, and pain from other causes were present. Group A included patents with dry socket alone; group B included patients with pain in the adjacent tooth alone; and group C included patients with both. The duration of symptoms was recorded. In addition, the prognosis of pain was divided into the complete improvement, improvement, maintenance, deterioration, and complete deterioration groups. Results: A total of 312 mandibular third molars were extracted from 13, 60, and 10 patients in groups A, B, and C, respectively. The mean duration of symptoms was 5 days in group A and B and 15.2 days in group C. There were statistically significant differences in the duration of symptoms between groups A and C and groups B and C. Conclusion: Pain in the adjacent tooth after third molar extraction can be caused by inflammatory reactions and pressure on this tooth. The pain caused by pressure on the periodontal ligament and alveolar bone results from the cytokines released by osteoclasts, which are responsible for bone destruction. However, pain from periodontal ligament damage caused by excessive pressure may be misunderstood as pulpal pain. Unconscious parafunctional habits, such as clenching and bruxism, could also be associated with post-extraction pain.

• Journal of Oral Medicine and Pain
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• v.32 no.4
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• pp.455-460
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• 2007

Majority of toothache is caused by abnormality of pulpal or periodontal tissues. However, there are numerous nonodontogenic sources that may be responsible for pain felt in the tooth. Nonodontogenic toothache may result from muscle, maxillary sinus, neuropathic, neurovascular, even cardiac and psychogenic problems. Myofascial pain is one of the most common abnormality characterized by palpation of a hard band which acts as the trigger point that causes stiffness and fatigue of the muscle, referral pain in tooth, tension-type headache, and hyperalgesia. Masseter muscle particularly induce referral pain in maxillary and mandibular molars. This case reported the treatment of the pain in right mandibular molar originated from myofascial pain of the right masseter. The pain is improved by general and reversible treatments such as muscle exercise, physical therapy, and medication. Nonodontogenic toothache should undergo proper differential diagnosis in order to avoid unnecessary dental treatments, such as endodontic, periodontic treatment, and tooth extraction, which would fail to alleviate the symptom of the patient.