感染根管细菌内毒素的致病机制与清除策略

细菌内毒素会影响牙髓根尖周疾病的发生发展及其治疗的预后。探究细菌内毒素的致病机制及清除措施对提高根管治疗的成功率及获得远期良好预后均有重要意义。本文就根管内细菌内毒素的产生、分布、致病机制以及清除策略等方面作一综述,为临床及基础研究提供新依据和新思路。     

Does Acetaminophen/Hydrocodone Affect Cold Pulpal Testing in Patients with Symptomatic Irreversible Pulpitis? A Prospective,Randomized, Double-blind,Placebo-controlled Study

Introduction

The purpose of this prospective randomized, double-blind, placebo-controlled study was to determine the effects of a combination dose of 1000 mg acetaminophen/10 mg hydrocodone on cold pulpal testing in patients experiencing symptomatic irreversible pulpitis.

Methods

One hundred emergency patients in moderate to severe pain diagnosed with symptomatic irreversible pulpitis of a mandibular posterior tooth randomly received, in a double-blind manner, identical capsules of either a combination of 1000 mg acetaminophen/10 hydrocodone or placebo. Cold testing with Endo-Ice (1,1,1,2 tetrafluoroethane; Hygenic Corp, Akron, OH) was performed at baseline and every 10 minutes for 60 minutes. Pain to cold testing was recorded by the patient using a Heft-Parker visual analog scale. Patients' reaction to the cold application was also rated.

Results

Cold testing at baseline and at 10 minutes resulted in severe pain for both the acetaminophen/hydrocodone and placebo groups. Although pain ratings decreased from 20–60 minutes, the ratings still resulted in moderate pain. Patient reaction to cold testing showed that 56%–62% had a severe reaction. Although the reactions decreased in severity over the 60 minutes, 20%–34% still had severe reactions at 60 minutes. Regarding pain and patients' reactions to cold testing, there were no significant differences between the combination acetaminophen/hydrocodone and placebo groups at any time period.

Conclusions

A combination dose of 1000 mg of acetaminophen/10 mg of hydrocodone did not statistically affect cold pulpal testing in patients presenting with symptomatic irreversible pulpitis. Patients experienced moderate to severe pain and reactions to cold testing.     

Neural changes in ulcerative and hyperplastic pulpitis: a transmission electron microscopic study

The purpose of this study was to examine at ultrastructural level the neural changes in human apical pulps of teeth clinically diagnosed as having ulcerative or hyperplastic pulpitis. Seventeen specimens were prepared from six teeth with ulcerative or hyperplastic pulpitis and four specimens from two sound teeth. After routine procedures the specimens were examined under an electron microscope for changes in the structure of myelinated and unmyelinated nerve fibres. Although the teeth used in this study responded positively to vitality test, the results revealed that moderate to severe degenerative changes occurred in the nerve fibres of the apical pulps of the teeth showing these two diseases.     

Intraoral Somatosensory Alterations Impact Pulp Sensibility Testing in Patients with Symptomatic Irreversible Pulpitis

IntroductionThis case-control study aimed to compare trigeminal somatosensory sensitivity between patients with a clinical diagnosis of symptomatic irreversible pulpitis (n = 33) and healthy participants (n = 33) and to evaluate the impact of somatosensory stratification of symptomatic irreversible pulpitis on pulp sensibility testing.MethodsA standardized battery of qualitative sensory assessment measured intra- and extraoral sensitivity to touch, cold, and pinprick stimuli. Dental pain intensity (0–100, numeric rating scale) and duration (seconds) evoked by cold stimuli (refrigerant spray) were applied to, respectively, the nonaffected and affected tooth (cases) and the upper right and left premolars (controls); z score transformation, analysis of variance (ANOVA), and chi-square tests were applied to the data (P = .050).ResultsPatients with irreversible pulpitis reported intraoral hypersensitivity more frequently than healthy participants (58% and 33%, respectively; P < .05). In addition, patients with irreversible pulpitis reported higher z scores of pain intensity (ANOVA main effects, F = 37.10, P < .05, partial η² = 0.37) and duration (ANOVA main effects F = 23.3, P < .05, partial η² = 0.27) after the pulp sensibility test compared with healthy participants. Nevertheless, subgroup analysis taking into account the presence of intraoral hypersensitivity indicated that the pain lingered most for patients with symptomatic irreversible pulpitis who also presented intraoral hypersensitivity (Tukey test, P < .05) but with no differences between patients with irreversible pulpitis without intraoral hypersensitivity and healthy participants (Tukey test, P > .05).ConclusionsQualST is able to detect intraoral alterations in patients with symptomatic irreversible pulpitis that seem useful to stratify the patients into distinct subgroups. Therefore, somatosensory assessment of the adjacent tissues may provide diagnostic fine-tuning of dental pulp diseases.     

Relationship between Clinical Symptoms and the Microbiota in Advanced Caries

IntroductionThe composition and relative abundance of bacterial species change throughout the development of dental caries; however, how these changes relate to clinical symptoms remains elusive. In this study, we explored the relationship between clinical symptoms and specific microorganisms in advanced dentinal caries.MethodsA total of 111 permanent premolars and molars were used to simulate the progression from caries to pulpitis indirectly. Clinical symptoms were evaluated, and teeth were diagnosed according to the diagnostic criteria of the American Association of Endodontics. Samples were collected for 16S ribosomal DNA sequencing. Associations between the microbiota and clinical symptoms/diagnosis and the relationship between alpha diversity and clinical symptoms/diagnosis were evaluated independently by the linear discriminant analysis effect size and Spearman rank correlation analyses.ResultsThe 16S ribosomal DNA sequences were assigned to 13,852 operational taxonomic units. The linear discriminant analysis effect size and Spearman correlations unveiled negative associations between the relative abundance of Bacteroidia and Gammaproteobacteria and referred pain, Gammaproteobacteria and the electric pulp test response, and Actinomyces and Propionibacterium and diagnosis (r < 0.0, P < .05). Conversely, the relative abundance of Lactobacillus was positively correlated to referred pain, the cold test, the percussion response, and diagnosis (r > 0, P < .05). Lactobillus reuteri, a probiotic bacterium, was more abundant in teeth with referred pain and teeth diagnosed with symptomatic irreversible pulpitis. The Spearman correlation between alpha diversity and clinical symptoms/diagnosis was not significant (P > .05).ConclusionsClinical symptoms and diagnosis were significantly associated with specific microorganisms in the most advanced layers of dentinal caries.