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NSAID before a block may help in pulpitis, weak evidence
Jaw osteonecrosis very rare on osteoporosis drugs; cancers mimicking an abscess and a salivary stone
TL;DR
- Oral NSAID premedication: pulpitis block success 64.6% versus 28.4% with placebo, low certainty; still plan supplemental anesthesia.
- Undiagnosed pre-diabetes (10.0%) and type 2 diabetes (3.0%) were found in UK dental attendees aged 40 or older.
- Jaw osteonecrosis was very rare, 0.18% over 20 years, on osteoporosis antiresorptives; recent invasive procedures were linked to higher risk.
Guidelines
International expert key points on botulinum toxin for orofacial pain and jaw joint disorders
Botulinum toxin is positioned as an off-label, second-line add-on for orofacial pain, never a replacement for conservative care.
An expert working group from INfORM/IADR agreed on key points for botulinum toxin in orofacial pain and temporomandibular disorders, covering diagnosis, patient selection, training and safety. They treat it as an unapproved-use, backup option that supplements, and never substitutes for, conservative care and patient self-care.
What changed: The statement sets out a standard of care for botulinum toxin use in orofacial pain. It calls it adjunctive, off-label and second-line, and advises avoiding inappropriate treatment.
Issued by INfORM/IADR
Key Studies
NSAID premedication improves pain-free nerve block success in painful irreversible pulpitis, with low certainty
Premedicating with an oral NSAID may improve block success in irreversible pulpitis, but still plan for supplemental anesthesia.
A meta-analysis of 11 randomized trials with 737 patients found pain-free nerve block success of 64.6% with oral NSAID premedication versus 28.4% with placebo in painful irreversible pulpitis of mandibular posterior teeth (RR 2.06, 95% CI 1.48-2.86). Certainty was low, heterogeneity was substantial, and the prediction interval crossed no effect.
Longer antiresorptive exposure and recent dental procedures linked to jaw osteonecrosis in veterans with osteoporosis
MRONJ was very rare in osteoporosis patients, but longer drug exposure and recent invasive dental procedures were associated with higher risk, based on few events.
Among 42,378 veterans taking antiresorptives for osteoporosis, 44 developed MRONJ, a 20-year cumulative incidence of 0.18%. Each added year of antiresorptive exposure was associated with a hazard ratio of 1.34, and a recent invasive dentoalveolar procedure with 4.40.
Undiagnosed pre-diabetes and diabetes found in adults attending NHS dental practices
Undiagnosed pre-diabetes and diabetes were common in these UK dental attendees, and risk questionnaires caught most cases but flagged many people without disease.
Among 803 adults aged 40 or older without a diabetes diagnosis, tested at 13 NHS dental practices, 10.0% had pre-diabetes and 3.0% had undiagnosed type 2 diabetes on point-of-care HbA1c. Two risk questionnaires had sensitivity above 80% but specificity below 55%.
About 95% of dental implants survive 10 to 25 years, but success rates are lower
Implants stay in place about 95% of the time beyond 10 years, but success and peri-implant health are less certain and vary by definition.
On-demand versus scheduled ibuprofen and acetaminophen after treatment of painful teeth with apical periodontitis
On-demand dosing gave pain scores not significantly different from scheduled dosing with less medication, though one center and many missing diaries leave some doubt.
Cases
One patient or a small series — what to take from them.
Jaw carcinoma under intact mucosa mistaken for a tooth abscess in one man
In this patient, a destructive jaw lesion that did not respond to infection treatment was cancer, so biopsy rather than waiting was warranted.
Sublingual gland carcinoma mistaken for a salivary stone in a 31-year-old woman
In this patient, a presumed salivary stone was an aggressive cancer, so a floor-of-mouth swelling that progresses despite unremarkable imaging needs prompt re-assessment.
Early Research
Lab and animal studies, not yet tested in patients.
Most probiotic toothpastes and mouthrinses tested lacked viable probiotics matching their labels
Label claims on probiotic toothpastes and mouthrinses may not hold up in the lab, so patients' expectations of benefit lack support from this work.