Department of Biosciences, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil.
Department of Department of Dentistry, Endodontics, and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil.
J Endod. 2020 Jun;46(6):786-793. doi: 10.1016/j.joen.2020.03.012. Epub 2020 Apr 25.
This 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.
A 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).
Patients 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 η = 0.37) and duration (ANOVA main effects F = 23.3, P < .05, partial η = 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).
QualST 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.
本病例对照研究旨在比较临床诊断为症状性不可复性牙髓炎患者（n=33）与健康对照者（n=33）的三叉神经体感敏感性，并评估症状性不可复性牙髓炎的体感分层对牙髓感觉测试的影响。
采用标准化的定性感觉评估量表测量口腔内和口腔外对触、冷和刺痛刺激的敏感性。冷刺激（制冷剂喷雾）分别应用于非患牙和患牙（病例）以及右上和左上前磨牙（对照），以评估牙本质痛强度（0-100，数字评分量表）和持续时间（秒）；对数据进行 z 分数变换、方差分析（ANOVA）和卡方检验（P=0.050）。
不可逆性牙髓炎患者报告口腔内过敏的频率高于健康对照者（分别为 58%和 33%；P<0.05）。此外，不可逆性牙髓炎患者在牙髓感觉测试后报告的疼痛强度 z 评分更高（ANOVA 主效应，F=37.10，P<0.05，偏η=0.37）和疼痛持续时间 z 评分更高（ANOVA 主效应，F=23.3，P<0.05，偏η=0.27）与健康对照组相比。然而，考虑到口腔内过敏的存在进行亚组分析表明，对于同时表现出口腔内过敏的症状性不可逆性牙髓炎患者，疼痛持续时间最长（Tukey 检验，P<0.05），但无口腔内过敏的不可逆性牙髓炎患者与健康对照组之间无差异（Tukey 检验，P>0.05）。
QualST 能够检测出症状性不可复性牙髓炎患者口腔内的改变，这些改变似乎有助于将患者分为不同的亚组。因此，对相邻组织的体感评估可能为牙髓疾病的诊断提供精细调整。
