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Pain levels and typical symptoms of acute endodontic infections: a prospective, observational study

BACKGROUND: This study aimed to identify key symptoms that could be associated with the diagnosis of acute forms of symptomatic apical periodontitis (SAP) and symptomatic irreversible pulpitis (SIP), and to identify a diagnostic algorithm based on these symptoms. METHODS: In this prospective, observ...

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Autores principales: Rechenberg, Dan-Krister, Held, Ulrike, Burgstaller, Jakob M., Bosch, Gabriel, Attin, Thomas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4884369/
https://www.ncbi.nlm.nih.gov/pubmed/27234432
http://dx.doi.org/10.1186/s12903-016-0222-z
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author Rechenberg, Dan-Krister
Held, Ulrike
Burgstaller, Jakob M.
Bosch, Gabriel
Attin, Thomas
author_facet Rechenberg, Dan-Krister
Held, Ulrike
Burgstaller, Jakob M.
Bosch, Gabriel
Attin, Thomas
author_sort Rechenberg, Dan-Krister
collection PubMed
description BACKGROUND: This study aimed to identify key symptoms that could be associated with the diagnosis of acute forms of symptomatic apical periodontitis (SAP) and symptomatic irreversible pulpitis (SIP), and to identify a diagnostic algorithm based on these symptoms. METHODS: In this prospective, observational study 173 emergency patients diagnosed with acute pain of endodontic origin and no swelling or fistula were included. Patients were asked 11 specific questions from a checklist with a possible discerning value between acute SAP and acute SIP. Pain levels were recorded using the numeric rating scale (NRS-11). Subsequently, the painful tooth was diagnosed. Logistic regression was used to evaluate the checklist regarding its differentiation between SAP (N = 103) and SIP (N = 70). Moreover, a decision tree was constructed based on recursive partitioning to identify a hierarchy in differentiating symptoms. RESULTS: With identical median NRS-11 scores of 8, the teeth diagnosed with acute SAP and SIP were severely painful. The decision tree analysis resulted in a tree with splits according to pain on cold, perceived tooth extrusion, and pain duration. The overall sensitivity of the tree to detect SAP based on key symptoms was 95 %, its specificity was 31 %. CONCLUSIONS: The best indicator for SAP was a reported absence of pain to cold stimuli. In teeth that did have a history of pain triggered by cold stimuli, the decision tree correctly identified SAP in 72 % of the teeth that felt too high and had hurt for less than one week.
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spelling pubmed-48843692016-05-29 Pain levels and typical symptoms of acute endodontic infections: a prospective, observational study Rechenberg, Dan-Krister Held, Ulrike Burgstaller, Jakob M. Bosch, Gabriel Attin, Thomas BMC Oral Health Research Article BACKGROUND: This study aimed to identify key symptoms that could be associated with the diagnosis of acute forms of symptomatic apical periodontitis (SAP) and symptomatic irreversible pulpitis (SIP), and to identify a diagnostic algorithm based on these symptoms. METHODS: In this prospective, observational study 173 emergency patients diagnosed with acute pain of endodontic origin and no swelling or fistula were included. Patients were asked 11 specific questions from a checklist with a possible discerning value between acute SAP and acute SIP. Pain levels were recorded using the numeric rating scale (NRS-11). Subsequently, the painful tooth was diagnosed. Logistic regression was used to evaluate the checklist regarding its differentiation between SAP (N = 103) and SIP (N = 70). Moreover, a decision tree was constructed based on recursive partitioning to identify a hierarchy in differentiating symptoms. RESULTS: With identical median NRS-11 scores of 8, the teeth diagnosed with acute SAP and SIP were severely painful. The decision tree analysis resulted in a tree with splits according to pain on cold, perceived tooth extrusion, and pain duration. The overall sensitivity of the tree to detect SAP based on key symptoms was 95 %, its specificity was 31 %. CONCLUSIONS: The best indicator for SAP was a reported absence of pain to cold stimuli. In teeth that did have a history of pain triggered by cold stimuli, the decision tree correctly identified SAP in 72 % of the teeth that felt too high and had hurt for less than one week. BioMed Central 2016-05-27 /pmc/articles/PMC4884369/ /pubmed/27234432 http://dx.doi.org/10.1186/s12903-016-0222-z Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Rechenberg, Dan-Krister
Held, Ulrike
Burgstaller, Jakob M.
Bosch, Gabriel
Attin, Thomas
Pain levels and typical symptoms of acute endodontic infections: a prospective, observational study
title Pain levels and typical symptoms of acute endodontic infections: a prospective, observational study
title_full Pain levels and typical symptoms of acute endodontic infections: a prospective, observational study
title_fullStr Pain levels and typical symptoms of acute endodontic infections: a prospective, observational study
title_full_unstemmed Pain levels and typical symptoms of acute endodontic infections: a prospective, observational study
title_short Pain levels and typical symptoms of acute endodontic infections: a prospective, observational study
title_sort pain levels and typical symptoms of acute endodontic infections: a prospective, observational study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4884369/
https://www.ncbi.nlm.nih.gov/pubmed/27234432
http://dx.doi.org/10.1186/s12903-016-0222-z
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