Endodontic Pain

Parafunctional habits can result in injury to the PDL, alveolar bone loss, sensitivity to hot and cold, cervical erosion, mobility, and may even cause tooth fracture. Pain referred from the PDL can be confused with pulpitis. If endodontic treatment is initiated there will be no pain relief. Therefore, good history taking and intra-oral and extra-oral examinations are essential. Pain from oral mucosal lesions can produce localized or diffuse pain that is usually described as soreness or burning sensation and is usually associated mucosal breakdown. However, toothache is usually distinguishable from pain of the oral

Central sensitization (CS) is a condition of the nervous system that is related to the development and maintenance of chronic pain. When CS happens, the nervous system goes through a process called “wind-up” and gets regulated in a persistent state of high reactivity. This persistent, or regulated, state of reactivity later on maintains pain even after the initial injury might have healed.

While pain is a subjective feeling, and an unpleasant sensation there is not one definition that explains what exactly pain is. We do however know that a pain pathway helps understand what pain is. Pain begins from a painful stimulus which activates nociceptor or pain receptors. This receptor sends pain signals to the spinal cord synapse. At this point a reflex response to the pain, which helps move the body away from the source of pain. Neurons then communicate to the ascending tracts to the brain. Two tracts; one for acute sharp pain called neospinothalamic tract and the paleospinothalamic tract for slower impulses. The tracts connect to the reticular formation in the brainstem, hypothalamus, thalamus and other structures. (Karin C. VanMeter,

The pulp of teeth repeatedly undergoes irreversible disease caused by caries, trauma, congenital abnormalities, or as a complication of previous dental procedures (7). Endodontic therapy aims to an effective and specific treatment for the irreversibly diseased pulp, with preferable short- and long-term outcomes (7,8). However, endodontic prognosis studies have conclusively shown that the presence of pre-operative infection, generally determined by lack of response to vitality tests and the presence of a radiolucent periapical lesion, reduces the long-term outcomes of treatment by about 15-20%, compared with cases with vital pulp (8). While the prognosis of endodontic treatment in these cases remains favorable, the situation is more complicated incases with young immature teeth. Root canal instrumentation, disinfection, and sealing are more technically difficult to performing these cases (9-11). Perhaps more importantly, the tooth remains weak and is therefore susceptible to fracture due to functional stresses or minor trauma, an outcome that has been determined to range from 28-77%, depending on the degree of root maturation (13).This distinction is important, given that calcium hydroxide is rarely used long-term today, because of the availability of apexification techniques that rely on these of

Pain medications and nonsteroidal anti-inflammatory drugs (NASAIDs) can provide some relief, and some dentists recommend oral appliances called splints to be worn for a short period of time. Additionally, there’s a lot your employees can do to ease their painful symptoms, like eating soft foods, applying ice packs and avoiding extreme jaw movements, such as yawning widely, singing loudly or chewing gum. Many dentists refer their patients with jaw problems to a physical therapist, who may suggest exercises that can provide relief. Learning stress-reducing techniques is also beneficial when dealing with facial pain.

Neuropathic pain is a broad category of non-odontogenic orofacial pain that should be in the differential diagnosis. Trigeminal neuralgia is often described as sharp, shooting, and stabbing pain.6 There is usually a trigger point which responds to light tactile, but not painful, stimuli. Pain is not provoked by thermal stimulus and local anesthetic block of the trigeminal nerve is effective in arresting the pain. Other neuralgias include glossopharyngeal and post-herpetic neuralgia.

The maxillary branch of the trigeminal nerve (V2) passes through the foramen rotondo in the sphenoid bone to reach the face and give the skin of the center of the face. The mandibular division of the trigeminal nerve (V3) passes through the foramen ovale of the sphenoid provide lower face with sensory innervations (Fig. 2) (“IX. Neurology. 5e. The Trigeminal Nerve. Gray, Henry. 1918. Anatomy of the Human Body.,” n.d.). From physiologic point of view the possible pathway of migraine pain consists of (Fig 1), first-order sensory neurons of the trigeminal nerve with axons capable of transmitting nociceptive sensations from the face, skull, meninges and intracranial blood vessels; second-order neurons in the spinal trigeminal nucleus, which extend between the obex and upper three segments of the cervical spinal cord, receiving input from the intracranial meninges, the occipital region of the head and neck muscles; the third-order neurons in the thalamus; and higher-order neurons in the cortical regions that elaborate the message (Burstein, et al.,

Post Obturation pain can be defined as pain of the facial soft tissues and the oral mucosa after the initiation of root canal treatment of the endodontically treated tooth that

Chronic pain and inflammation increases serotonin receptor density in the DRG and spinal cord (Bardin, 2011). Spinal 5-HT3 receptors in particular are implicated in central sensitization (Kayser et al., 2007; Zeitz et al., 2002). 5-HT3 antagonists relieve pain intensity in patients with FMS (Vergne-Salle et al., 2011; Wolf, 2000). While they do appear to play a role in decreasing acute pain in tail-flick and thermal plate tests in rats (Glaum, Proudfit, & Anderson, 1988) they also increase wind-up and sensitization, two phenomena that characterize FMS pain, and are most often associated with pronociceptive signaling (D'Mello & Dickenson, 2008; Suzuki et al., 2004). 5-HT3 receptors are believed to have an important role in supraspinal facilitation and hyperalgesia (Dogrul et al., 2009). These receptors enhance the release of nociception promoting substances such as substance P, calcitonin gene-related peptide, and neurokinin A (Bannister et al., 2009). Symptoms that

Endodontic refers to that field of dentistry that deals with diagnosing and treating pulpal and periapical diseases as to preserve the surrounding tissue. (1) Until recently, root canal treatment therapy was traditionally performed using tactile sensation of the clinician and the root canal system could only be seen on a two-dimensional radiograph. To perform an endodontic treatment regularly means to work in a dark and narrowed place, and little bit of millimeters may decide the outcome of therapy, as it relays on the dentist knowledge and expertise many results were achieved by chance. (2)

Neuropathic pain is a common condition resulted ref from pathology of the nervous system. It is a common syndrome comprising hyperalgesia, allodynia and spontaneous pain. The chronic constriction injury (CCI) of the sciatic nerve is a widely used model of neuropathic pain which evokes a series of molecular, biochemical and cytoarchitectural changes in primary sensory neurons and produces neuropathic

According to the European Federation of Neurological Societies (EFNS) guidelines on neuropathic pain assessment and the American Acade-my of Neurology (AAN)-EFNS guidelines on TN management (Cruccu G et al., 2006) the neurophysiological recording of trigeminal reflexes represents the most useful and reliable test for the neurophysiological diagnosis of trigeminal pains. (Figure 1.1). In patients presented with pain in the trigeminal territory, trigeminal reflexes offer the clinician with useful information. Abnormalities are often discovered in divi-sions that appear clinically unaffected. An objective demonstration of dysfunction is provided in all patients with pain secondary to a docu-mented disease, such as symptomatic trigeminal neuralgia,

Cavities can be a serious pain, especially if they get down into the nerve of your tooth. If you are experiencing pain with a cavity then it has likely done this, or you may have an infection

Our patient presented with a history much typically suggestive of trigeminal neuralgia. Dental extractions are sometimes considered as the trigger factor for the same. Patient also did not have any neurological deficits including sensory loss over trigeminal nerve distribution making trigeminal neuralgia a strong clinical possibility.

Patients were randomly alienated into 2 distinct groups of 30 patients. Single visit root canal treatment were perfomed by cleaning and shaping of canals by means of rotary files in group A while in group B hand K-files were used for shaping and cleaning via passive step-back technique followed by obturation and termporary filling on the same visit. Following the treatment, patients were directed to compute pain intensity at 4, 8, 12 and 24