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patient products

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Oralieve Dry Mouth Relief - effective and long-lasting relief for dry mouths. Making dry mouths happy again.

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patient products

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Biotène Products For A Dry Mouth | Biotène

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Discover useful information about a dry mouth and learn how Biotène products including mouthwash, gel and spray can help you relieve dry mouth signs.

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The S.O.C.R.A.T.E.S. Evaluation for Symptoms in History Taking

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For clinicians taking a history of a presenting illness, certain information should be sought routinely for each symptom if it hasn't alread...

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Correlation between clinical and histologic pulp diagnoses

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Correlation between clinical and histologic pulp diagnoses

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Correlation between Clinical and Histologic Pulp Diagnoses

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GDC Maintaining and protecting patient information

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GDC Maintaining and protecting patient information

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Guidance

4.1.1 You must make and keep complete and accurate patient records, including an up-to-date medical history, each time that you treat patients. Radiographs, consent forms, photographs, models, audio or visual recordings of consultations, laboratory prescriptions, statements of conformity and referral letters all form part of patients records where they are available.

4.1.2 You should record as much detail as possible about the discussions you have with your patients, including evidence that valid consent has been obtained. You should also include details of any particular patient's treatment needs where appropriate.

4.1.3 You must understand and meet your responsibilities in relation to patient information in line with current legislation. You must follow appropriate national advice on retaining, storing and disposing of patient records.

4.1.4 You must ensure that all documentation that records your work, including patient records, is clear, legible, accurate, and can be readily understood by others. You must also record the name or initials of the treating clinician.

4.1.5 If you need to make any amendments to a patient's records you must make sure that the changes are clearly marked up and dated.

4.1.6 If you refer a patient to another dental professional or other health professional, you must make an accurate record of this referral in the patient's notes and include a written prescription when necessary.

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General Dental Council - Maintain and protect patients' information

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Guidance 4.1.1 You must make and keep complete and accurate patient records, including an up-to-date medical history, each time that you treat patients. Radiographs, consent forms, photographs, models, audio or visual recordings of consultations, laboratory prescriptions, statements of conformity and referral letters all form part of patients records where they are available.

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Investigating acute management of irreversible pulpitis

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Investigating acute management of irreversible pulpitis

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Objective To investigate current strategies of acute management of irreversible pulpitis by general dental practitioners.

Design A postal survey was sent to a representative sample based on postal code to 180 dentists registered with the General Dental Council in the North East of England. The questionnaire identified general dental practitioners' strategies for the diagnosis and acute management of irreversible pulpitis.

Results One hundred and three questionnaires were returned. Irreversible pulpitis was primarily diagnosed from patients' signs and symptoms. There was a high confidence in anaesthetising a tooth with irreversible pulpitis. Treatment was undertaken with either pulpotomy (with a view to single or multi-stage orthograde root canal treatment) or full extirpation in just over half of respondents (51%). Seventy-one percent of respondents reported using different intrapulpal medicaments. Antibiotics were 'frequently' prescribed in cases of irreversible pulpitis by 25% of respondents. For endodontic procedures, dental dam usage was generally low and used 'occasionally' or 'never' by 40% of respondents.

Conclusions Antibiotics were being inappropriately prescribed in the management of irreversible pulpitis, transgressing from NICE guidelines on antibiotic usage. Rubber dam use is not universal during the initial management of pulpitis, or during the definitive endodontic procedure, impacting upon the safety and predicility of outcome. Respondents often placed medicaments into the pulp, in spite of a lack of evidence for their efficacy.

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Investigating acute management of irreversible pulpitis: a survey of general dental practitioners in North East England

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Objective To investigate current strategies of acute management of irreversible pulpitis by general dental practitioners. Design A postal survey was sent to a representative sample based on postal code to 180 dentists registered with the General Dental Council in the North East of England.

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Oral and dental implications of Ehlers-Danlos

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Oral and dental implications of Ehlers-Danlos

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Stephen Porter, Director and Professor of Oral Medicine, UCL Eastman Dental Institute, London

Please note: The following text cannot and should not replace advice from the patient's healthcare professional(s). Any person who experiences symptoms or feels that something may be wrong should seek individual, professional help for evaluation and/or treatment. This information is for guidance only and is not intended to provide individual medical advice.

Introduction

The Ehlers-Danlos Syndromes (EDS) give rise to a spectrum of features affecting the mouth that may lessen quality of life. Additionally, routine dental care has the potential to be compromised as a consequence of some of the systemic features of the disease. This article provides a review of the oral and dental aspects of EDS.

Orofacial manifestations

The oral and facial features of EDS vary with each type of disease. There have been few detailed studies of the orofacial manifestations of the rare and/or recently described types of EDS. In general the greater the laxity of the skin and mucosa the more likely that someone will have orofacial features. Similarly, the haemorrhagic types are more likely than others to give rise to gingival (gum) bleeding.

The various potential orofacial features of EDS are detailed below.
Eyes
Epicanthic folds: these are folds that extend from the nasal bridge to the upper eyelids and can give the appearance of a widened nasal bridge. These seem to be most common in classical and kyphoscoliotic EDS. Epicanthic folds may lessen with age or change to increased distance between the eyes, giving the appearance of wide spread eyes.

Other ocular features of EDS include puffy or prominent upper eyelids, blue sclera (classical, kyphoscoliotic and arthrochalasia types), the ability to evert the upper eyelid (Meitenier's sign, classical type), myopia (short-sightedness, classical type) and strabismus (squint, classical type). People with vascular EDS may have large prominent 'staring' eyes due to a lack of subcutaneous tissue. Kyphoscoliotic EDS may give rise to down-staring palpebral fissures.
Ears
There may be a lack of ear lobes and the pinna of the ear may be firm (vascular type).
Nose
The bridge of the nose can be widened or ﬂattened (classical and kyphoscoliotic types) while in vascular EDS the nose can appear pinched or sharp.
Facial skin and appearance
The skin may be hyperelastic (very stretchy) and there may be 'cigarette paper' scarring of the face and forehead (classical type). Individuals with vascular EDS have a distinct facial appearance of prominent eyes (see above), sharpened nose, thin lips and hollow cheeks, sometimes collectively termed 'acrogenic' facies (older appearance). The lower jaw has been suggested to be of reduced size in some patients. Brown spots (termed Café-au-lait macules) may have been observed on the skin of the neck in some types of EDS.
Oral
About 50% of individuals with EDS have the ability to touch the tip of the nose with their tongue (Gorlin's sign) - this is especially likely with classical and hypermobile EDS. The oral mucosa may be thin, easily tear and give rise to mouth ulcers (classical and hypermobile EDS). Individuals with these types may also lack labial and/or lingual frenulae (the folds of mucosa that are in the midline of the lips and beneath the tongue). Dislocation of the jaw joint (temporomandibular joint) is a possible feature of classical and hypermobile EDS and possibly some subtypes of arthrochalasia EDS.

A spectrum of dental anomalies have been described, particularly in the classical and hypermobile types, including high cusps and deep fissures of premolars and molars, shortened or abnormally-shaped roots with stones in the pulp of crowns, and enamel hypoplasia (underdevelopment) with microscopic evidence of various enamel and/or dentine defects. The enamel defects may predispose to easy loss of the tissue of crowns (attrition) and if these give rise to a loss of calcification of the enamel will increase the risk of caries. Multiple odontogenic keratocysts (that have the potential to cause local bony destruction of the jaws) have been described in vascular EDS.

An increased liability to gum disease (gingivitis and periodontitis) has been described in periodontal EDS, this having the potential to cause early tooth loss in adults. Periodontal disease has also been suggested to arise in classical and vascular EDS.

Implications for oral health care

EDS has the potential to lessen oral health by virtue of increasing the risk of dental decay (caries) as a consequence of the dental anomalies - these can trap food and dental plaque. Caries initially give rise to painless white and darkened areas of the crowns, but without treatment will cause painful pulpitis ('toothache' with hot, cold and sweet foods) and later death of the tooth and painful abscess formation (periapical periodontitis). Additionally, patients with some types of EDS may have an increased liability to gum disease (especially periodontitis). Inﬂammation of the superficial gums (gingivitis) causes swelling and bleeding, and may give rise to easy gingival bleeding, an unpleasant taste and oral malodour (halitosis). Inﬂammation of the deeper tissues (the periodontium) also causes bad breath and altered taste, but can also lead to mobility and migration of teeth, and potentially early loss of teeth. It must also be recalled that some patients with EDS may have gums that bleed more easily as part of their underlying connective tissue disorder.

Prevention of tooth decay and gum disease is cardinal for all persons as this avoids the need for complex dental treatment and lessens the risk of loss of time from education or employment that would occur in having to have dental treatment. Furthermore, invasive dental procedures such as dental extractions or complex treatment of periodontal disease may be complicated by poor wound healing and possibly excess post-surgical bleeding. Thus there is a need for ALL individuals with EDS to have a diet that avoids the development of caries and maintain a high standard of oral hygiene that will lessen the risk of caries and gum disease.

Maintaining good oral health

The principles of sustaining good oral health are centred upon dietary restriction of sugars and maintaining a good oral hygiene regime.
Dietary considerations
Sugars increase the risk of tooth decay as plaque bacteria thrive on these and generate acids that can attack the teeth and cause caries. The simple measures that lessen acidic damage to the teeth are:

To avoid excess sugary foods

Eat sweet foods only at meal times (sugary drinks or snacks between meals will increase the frequency of acidic attack upon teeth)

To avoid sticky sweet foods (e.g. toffees) as these will not be easily dislodged with normal mouth action or saliva. Foods that contain sugar substitutes such as sorbitol are not as harmful as those that contain sucrose, glucose or fructose, but the sugar substitutes can cause gastrointestinal upset in some individuals - so take care!

Hard fruits and vegetables do not greatly remove plaque from the teeth, but they do contain less sugar than sweets and snacks and thus are an alternative to the latter. Similarly, savoury snacks that do not contain sugars, e.g. peanuts, cause no notable harm to the teeth, indeed salty snacks may actually protect the teeth by stimulating the ﬂow of saliva.

Diet need not be boring. There is no need to entirely avoid sugars - provided individuals are sensible and maintain a high standard of oral hygiene (see below) their risk of caries will generally be low.
Good oral hygiene Tooth brushing
Plaque must be removed from the teeth, otherwise the bacteria will cause caries and gum disease. The teeth should be cleaned at least twice a day using a suitable toothbrush and a ﬂuoride-containing toothpaste. The brush should have a small head that will allow all accessible surfaces of the teeth to be reached. The bristles should be not be hard as this may cause loss of tooth tissue if there is any exposure of roots at the gum margin. A variety of techniques can be used (e.g. a gentle up-and-down rolling or figure of eight action), but importantly the teeth should not be scrubbed in a horizontal direction as this increases the risk of damage to the gums and any exposed root surfaces. Brushing should include gentle massage of the gum margin, as this will help to remove any plaque trapped beneath this site. EDS is unlikely to have any significant implications for tooth brushing.
Interdental cleaning
Toothbrushes only remove the plaque and debris from the upper and exposed (smooth) surfaces of teeth, hence the areas between teeth (interdental sites) require to be cleaned separately. A variety of interdental aids are available particularly floss, interdental brushes and interdental sticks. Floss needs to be used carefully to avoid traumatising the gums, but the ﬂoss should be ﬂicked below the gum margin to remove any plaque that always accumulates at this site. Brushes and sticks must be used carefully to avoid damaging the gums - they should never be forced between the teeth, indeed sticks are best used when there are obvious spaces between the teeth. Floss holders can aid ﬂossing, particularly if individuals have difficulties in reaching the posterior teeth. EDS is unlikely to have any significant implications upon interdental cleaning other that the avoidance of trauma.

Fluoride hardens the surface enamel of teeth and lessens the risk of caries. Children living in a geographic region where the ﬂuoride content of water is naturally or artificially at a level of one part per million will have enamel that has increased strength and greater resistance to dental decay. Fluoride in toothpastes and mouthwashes will lessen the resistance of decay of only the surface layer of enamel. Without doubt ﬂuorides are thus of benefit and are recommended for all individuals with EDS. Twice daily use of a ﬂuoride-containing toothpaste is thus recommended. Fluoride mouthwashes can also be helpful although are probably not required if a patient is already using a ﬂuoridated toothpaste. Fluoride tablets are of no significant benefit to adults (as the teeth have already formed) although may be advantageous to children living in regions where the water is not fluoridated.
Antimicrobial mouthwashes
Antimicrobial mouthwashes may reduce the risk of gingivitis and periodontitis and may lessen oral malodour. A wide range of mouthwashes are available; these should be used on a daily basis. Mouthwashes based upon chlorhexidine cause superficial staining of the teeth, although this may be lessened by using them immediately following tooth cleaning and the stain can be removed by professional cleaning by a dentist, hygienist or therapist. There is no strong evidence that alcohol-containing mouthwashes increase the risk of mouth cancer.
Regular attendance at a dentist
Dentists have an important role in the identification and treatment of common dental disease. In addition they will be able to arrange referral to appropriate specialists if a patient has complex disease or possible oral manifestations of EDS that warrants further investigation or treatment. It is advisable for all patients to attend a dentist on a six-monthly basis. Although there have been publicised concerns that not all people have ready access to an NHS dentist it is probable that this will improve as a consequence of recent initiatives by the NHS. Members of EDS UK who encounter difficulties in obtaining dental care should contact the author for guidance as to how this can be resolved.

Considerations for different oral problems
Dental extractions
There are two concerns with regard to dental extractions of individuals with EDS - risk of endocarditis and excessive post-extraction bleeding.
Risk of endocarditis
When teeth are extracted, bacteria from the gums pass into the bloodstream. In patients with cardiac valve abnormalities there is a risk that the bacteria will attach to the valve(s) and cause inﬂammation (endocarditis) that can affect cardiac function as well as give rise to systemic disease. It was previously advised that all patients with valvular defects required antibiotics before dental extractions to prevent possible endocarditis; however the National Institute for Clinical Excellence (NICE) has now concluded that the risk of endocarditis following dental extractions in the vast majority of patients with known cardiac valve disease is low and that antibiotics (antibiotic prophylaxis) are not indicated. Nevertheless not all cardiologists agree with this recommendation. It would thus seem sensible for a dentist to contact a patient's cardiologist to determine if he/she wishes antibiotics to be prescribed for any planned dental extractions. If the dentist does not wish to prescribe antibiotics the specialist, if wishing them to be provided, will instead prescribe these and be medicolegally responsible for any adverse consequences (which is very unlikely).
Post-extraction bleeding
Patients with haemorrhagic types of EDS may be liable to excess post-extraction bleeding. However, in the vast majority of instances this will not arise as the dentist will place a haemostatic agent into the socket, carefully suture the gum and possibly provide a mouthrinse that prevents the clot from breaking down (tranexamic acid).

There have been occasional reports that the efficacy of local anaesthetics may be reduced in EDS. If this arises (which is rare) patients should be referred to a specialist in Oral and Maxillofacial surgery who will be able to ensure that a suitable technique or agent is used that provides effective anaesthesia.

There is little evidence that the healing of extraction sockets is greatly compromised in patients with EDS. If healing seems to be abnormal (e.g. sustained pain, swelling, bad taste) the patient should be referred to a specialist in Oral and Maxillofacial surgery who will clean the area and possibly provide antibiotics.
Gum disease (gingivitis and periodontitis)
As discussed above some types of EDS increase the risk of periodontitis. In addition people with EDS, like any other individual, are at risk of some periodontal disease that can ultimately lead to bad breath, gum bleeding, tooth mobility or tooth loss. Good oral hygiene will reduce the risk of periodontal disease. Additionally, individuals with periodontal disease should be treated by a specialist in periodontology who will be able to provide professional cleaning of the teeth and gums and when indicated surgery to improve the gum status. It was previously recommended that deep cleaning of the gums (scaling) required antibiotic prophylaxis, but as with dental extractions (see above) this may no longer be the case.
Dental restorations (fillings, crowns and bridges (sometimes termed fixed prosthodontics)) Dentures (removable prosthodontics)
There are no specific concerns for fixed prosthodontics for patients with any type of EDS. Large fillings or crowns that are below the gum margin are unlikely to cause any significant bleeding, and if this does arise it will probably stop with local pressure.
Endodontics (root canal treatment)
There are no specific concerns for removable prosthodontics for patients with any type of EDS. However, as some patients with EDS are more liable than others to develop mouth ulcers due to trauma from a loose denture, it is essential that dentures are well-fitting and regularly reviewed by a dentist.
Dental implants
Root canal treatment is required when a tooth dies (usually as a consequence of dental decay) or when an abscess forms at the base of the root. Endondontic therapy requires the root canal to be cleaned and filled (usually) with gutta percha. In EDS, endodontics may be complicated by the presence of pulp stones and/or the root having an unusual shape. In such instances endodontic therapy may be best undertaken by an appropriate specialist (an endodontist). Antibiotic prophylaxis is generally not warranted for endodontic treatment.
Orthodontics
Dental implants are titanium screws that are placed within bone. Crowns, bridges and dentures can then be attached to the implants. There are no detailed reports of the use of dental implants in patients with EDS, but few adverse side effects would be anticipated. As the placement of an implant is a surgical procedure the same considerations of antibiotic prophylaxis and post-surgical bleeding as for dental extractions apply.
Oral ulceration
Orthodontics is not contra-indicated for patients with EDS; however, treatment may have to be modified as in some patients the teeth migrate faster than would be expected. After the teeth have been positioned correctly there may be a need for patients to wear an appliance for many months to ensure that the teeth remain in position. Some patients with EDS may develop mouth ulcers due to the trauma of any orthodontic appliance. This can be lessened by use of protective wax over the brace and possibly an occlusive paste placed over any sites of ulceration.
Temporomandibular joint disease
Patients with EDS may develop mouth ulcers as a result of trauma from teeth or dentures. These are best avoided by ensuring that dentures are well-fitting. If ulcers arise a protective occlusive paste can be provided. It must be emphasised that any patient, regardless of their EDS type, who has persistent or recurrent mouth ulcers should be referred to an appropriate specialist (usually a specialist in Oral Medicine).

Recurrent dislocation of the temporomandibular joint (TMJ) may, very rarely, warrant surgical treatment. This always requires consultation with an Oral and Maxillofacial surgeon.

Conclusion

The Ehlers-Danlos Syndromes can have a significant impact upon oral health and mouth function; however the majority of patients will probably only be liable to the common disorders of the teeth and gums. Dentistry is unlikely to be greatly compromised by EDS and similarly patients are unlikely to have significant complications as a consequence of routine oral health care. Certainly, patients who have complex oral needs must be managed by appropriate clinicians such as specialists in Special Care Dentistry, Oral Medicine and Oral and Maxillofacial Surgery.

Date of last review: 01/04/2016

Date of next review: 01/04/2019

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Oral and dental implications of the Ehlers-Danlos syndromes

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Stephen Porter, Director and Professor of Oral Medicine, UCL Eastman Dental Institute, London Please note: The following text cannot and should not replace advice from the patient's healthcare professional(s). Any person who experiences symptoms or feels that something may be wrong should seek individual, professional help for evaluation and/or treatment.

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You have any of the main symptoms of sleep apnoea:

your breathing stops and starts while you sleep

you make gasping, snorting or choking noises while you sleep

you always feel very tired during the day

If someone else has seen you have the symptoms, it can help to bring them with you.

Sleep apnoea can be serious if it's not diagnosed and treated.

Coronavirus update: how to contact a GP

It's still important to get help from a GP if you need it. To contact your GP surgery:
Find out about using the NHS during coronavirus

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You have any of the main symptoms of sleep apnoea: your breathing stops and starts while you sleep you make gasping, snorting or choking noises while you sleep you always feel very tired during the day If someone else has seen you have the symptoms, it can help to bring them with you.

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national institute for health and clinical excellence

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Temporomandibular disorder (TMD) is a problem affecting the 'chewing' muscles and the joints between the lower jaw and the base of the skull.

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What is Burning Mouth Syndrome?

Burning Mouth Syndrome (BMS) is a hot feeling or sensation which can affect your tongue, lips, palate, or areas all over your mouth. BMS is sometimes called 'glossodynia'.

You get this feeling when there are changes in the way the nerves in your mouth send messages to your brain - for example, about taste and temperature. When your brain doesn't understand these messages properly it can cause the feeling of pain or burning.

Although some parts of your mouth may feel like they are burning, they will not be hot to the touch. You might not be able to see any soreness or redness in the areas that are hurting.

BMS is sometimes called a 'neuropathic pain', as it happens when there is damage to the nerves.

It's hard to say. No one knows exactly what causes BMS. However, some possible causes include:

Stress, anxiety or depression.

Problems with your immune system.

Damage to the nerves controlling taste or pain.

A reaction to certain types of toothpastes or mouthwashes.

Badly fitting dentures or being allergic to the materials used to make .

Are there any medical conditions that can cause it?

There are some medical conditions which might cause BMS. They are:

Acid reflux (when acid from your stomach comes up into your mouth).

(a fungal infection in your mouth, also called 'candida').

Nutritional deficiencies (for example, when your body does not make or store enough iron, vitamin B12 or folic acid).

In some cases, BMS may have more than one cause.

Anyone can have BMS, but it is more common in middle-aged or older women during the menopause (often called 'the change' or 'the change of life').

What kind of problems might I have?

You may have a moderate to severe burning feeling on your tongue, palate, lips, gums or inside your cheek.

For some people the feeling starts in the morning and builds up to a peak by the evening, often easing by night time. Some people have the burning feeling all the time. For others, the pain comes and goes. Other symptoms may include numbness or tingling of your mouth or tongue, a bitter or metallic taste, or a dry or sore mouth.

People often describe BMS as feeling like you have scalded your mouth with hot food or drink.

Your dentist will examine your mouth thoroughly to try to find the cause of the problem. They will also look at your medical history and may refer you to your doctor for 'investigations'. These could be blood tests or swabs - to see if there are any infections, nutritional deficiencies or other medical conditions.

You may need to have allergy testing done by a specialist dermatologist. Your doctor can refer you for this if needed.

You may also need blood tests to see if you have, for example, thyroid problems or diabetes.

What treatments are there?

Treatments for BMS can vary depending on the causes.

If BMS has been brought on by a poor diet, then your dental team can recommend supplements for you. If needed, your dental team can also adjust or replace irritating dentures or prescribe you medication for a fungal infection in your mouth.

Some doctors may prescribe a course of counselling and low-dose anti-depressants. This is because BMS can 'wear down' some people, and cause depression because they are having a daily battle with the pain. Doctors can also change your medication if your BMS has been caused by dry mouth (a side effect of some medications).

Other therapies can include relaxation, yoga, meditation and hypnotherapy, as they have been found to help some people cope with anxiety.

How can I ease the symptoms myself?

You can help to ease the symptoms yourself at home by:

Sucking on crushed ice.

Avoiding things that irritate your mouth - such as hot and spicy foods, mouthwashes that contain alcohol, or acidic fruits and juices.

Avoiding tobacco and alcohol products.

What should I do if I think I have burning mouth?

First of all, see your dental team for a check-up. They will then be able to find out if the cause is a dental one, such as your dentures or 'dry mouth'. If it is, your dental team can check the fit of your dentures (if you wear them) and can also see whether you are allergic to the material they are made from. They can also recommend products to ease dry mouth or get rid of any fungal infection.

If your dental team cannot find a dental cause, they may suggest that you see your doctor or refer you to a specialist. You can then have a blood test to try to find the cause of your BMS.

How long could I have BMS for?

As no one knows the exact causes of BMS, it is hard to plan a correct course of treatment. Therefore, BMS is a long-term condition which could affect you for months, years, or perhaps the rest of your life.

If you find ways of coping with and limiting the pain, and have treatments or therapies recommended by your doctor, there's no reason why you cannot do the things you did before.

It is important to keep a record of how your symptoms are affected by the different types of treatment. Your dental team or doctor will then have a better idea of what treatment is best for you - after all, everybody is different.

Are there any medical conditions that can cause it?

As with any long-term condition, dealing with constant day-to-day pain can get you down. Often this can lead to depression. If a cause for your BMS cannot be found, your doctor may prescribe a low-dose anti-depressant, or refer you for Cognitive Behavioural Therapy, to help you deal with this.

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oral health charity dental advice uk national smile month mouth cancer action month

# data[].attributes.attachment_link.description
Burning Mouth Syndrome (BMS) is a hot feeling or sensation which can affect your tongue, lips, palate, or areas all over your mouth. BMS is sometimes called 'glossodynia'. You get this feeling when there are changes in the way the nerves in your mouth send messages to your brain - for example, about taste and temperature.

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Accurate assessment of the health of the dental pulp is an important element of successful endodontic treatment. Diagnosis is commonly carried out using hot or cold thermal stimuli and electric pulp testing in recent years laser doppler and pulse oximetry have emerged as alternative and perhaps more accurate alternatives.

The aim of this systematic review was to investigate and compare the diagnostic accuracy of cold pulp testing (CPT), heat pulp testing (HPT), electric pulp testing (EPT), laser doppler flowmetry (LDF), and pulse oximetry (PO).

Methods

Searches were conducted in the PubMed, Scopus and Web of Science databases. Prospective or retrospective cohort study or cross-sectional studies of pulp diagnosis confirmed by histologic analysis, direct clinical observation (access cavity), or evidence of root canal filling (to confirm nonvital teeth) that provided enough data to calculate sensitivity, specificity, accuracy, positive predictive value (PPV), or negative predictive value (NPV) were considered. Quality of the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool

Results

28 studies were included.

14 studies had samples sizes smaller than 30 patients.

26 studies were considered to be of low quality, 1 of medium quality and 1 of high quality.

For pooled sensitivity LDF and PO showed the highest values.

Conclusions

The authors concluded: -

The most accurate pulp testing methods are LDF and PO, and the least accurate method is HPT. EPT has low sensitivity, suggesting that it is less likely to correctly identify nonvital teeth, but has high specificity, suggesting that it is more likely to correctly identify vital teeth. Among pulp sensibility tests, CPT has generally high diagnostic accuracy and can be considered a primary pulp testing method. Sensitivity, specificity, adjusted accuracy, adjusted PPV, and adjusted NPV were extracted or calculated from each study. Pooled estimates were calculated using a random effects model.

Comments

Three databases were searched for this review although it is not clear whether study selection data abstraction and quality assessment was carried out independently by the reviewers. The reviewers indicate that the used QUADAS to assess study quality although the table they present refers to this as modified QUADAS. A new QUADAS-2 tool is also now available and is the one recommended by the Cochrane Diagnostic Test Accuracy Reviews Handbook .

It is interesting to compare this review with the 2016 Alghaithy and Qualtrough review (Dental Elf - 20 th Mar 2017). That review searched a different range of databases including just 9 studies, all of which are included in this new review and concluded that LDF showed promise particularly in areas where pulp tests are thought to be unreliable. This review also suggests that LDF and pulse oximetry are the most accurate. Further primary studies in this area should be reported using STARD and systematic reviews should use the approaches outlines in the Cochrane Diagnostic Test Accuracy Reviews Handbook.

Links

Primary Paper

Mainkar A, Kim SG. Diagnostic Accuracy of 5 Dental Pulp Tests: A Systematic Review and Meta-analysis. J Endod. 2018 May;44(5):694-702. doi: 10.1016/j.joen.2018.01.021. Epub 2018 Mar 20. Review. PubMed PMID: 29571914.

Other references
Dental Elf - 20th Mar 2017
Dental pulp testing: insufficient evidence to evaluate clinical performance

Picture Credits
By Coronation Dental Specialty Group - Own work, CC BY-SA 3.0

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Dental pulp testing methods: which is best? - National Elf Service

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Accurate assessment of the health of the dental pulp is an important element of successful endodontic treatment. Diagnosis is commonly carried out using hot or cold thermal stimuli and electric pulp testing in recent years laser doppler and pulse oximetry have emerged as alternative and perhaps more accurate alternatives.

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Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies

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Objectives There is little consensus regarding the burden of pain in the UK. The purpose of this review was to synthesise existing data on the prevalence of various chronic pain phenotypes in order to produce accurate and contemporary national estimates.

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Spontaneous talking time at start of consultation in outpatient clinic: cohort study

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The average patient visiting a doctor in the United States gets 22 seconds for his initial statement, then the doctor takes the lead.1 This style of communication is probably based on the assumption that patients will mess up the time schedule if allowed to talk as long as they wish to. But for how long do patients actually talk, at least initially? We found only one study, from a neurological practice, investigating this question.2 The author reported one minute and 40 seconds. We examined how long it would take outpatients at a tertiary referral centre to indicate that they have completed their story—for example, with a statement such as: “That’s all, doctor!” if uninterrupted by their doctors. We investigated a sequential cohort of patients from the outpatient clinic of the department of internal medicine at the university hospital in Basle. The study protocol was approved by the university’s ethics …

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A Guide to Medications Inducing Salivary Gland Dysfunction, Xerostomia, and Subjective Sialorrhea: A Systematic Review Sponsored by the World Workshop on Oral Medicine VI

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Medication-induced salivary gland dysfunction (MISGD), xerostomia (sensation of oral dryness), and subjective sialorrhea cause significant morbidity and impair quality of life. However, no evidence-based lists of the medications that cause these…