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  • 1. Alkhateeb, Noor
    et al.
    Dawson, Jenny
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Pigg, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Patient-perceived features and clinical characteristics of tooth pain: A comparison between apical periodontitis and persistent dento-alveolar pain disorder (PDAP) – preliminary results2017Conference paper (Other academic)
    Abstract [en]

    Background: Differential diagnosis between tooth pain of inflammatory and neuropathic origin is crucial since treatment strategies differ. Aim: Evaluate and compare self-reported and clinically observed pain characteristics in patients with SAP (symptomatic apical periodontitis) and PDAP (persistent dento-alveolar pain disorder). Methodology: Patients diagnosed with SAP and PDAP were recruited from Malmö University and Folktandvården Östergötland. Data collection included clinical examination and questionnaire (tooth pain characteristics, verbal pain description [short-form McGill Pain Questionnaire; SF-MPQ], factors affecting the pain). Results: Data from 24 patients with SAP and 20 with PDAP (24 females, mean age 53 years) were analyzed. Average pain intensity was 4.4 (0–10 numeric rating scale) and average duration 1527 days. 64% reported continuous and 27% recurrent pain. 58% of teeth were tender to percussion and 66% to apical palpation. 27% reported concurrent pain from jaw muscles/joints. Significant differences were found for gender (% females; PDAP>SAP;p=0.013), pain duration (PDAP>SAP;p<0.0001), pain frequency (PDAP>SAP;p<0.001), percussion tenderness (SAP>PDAP;p=0.012), muscle/joint pain (PDAP>SAP;p=0.021). SF-MPQ and affecting factors did not differ (p=0.096–1.000). Conclusion: Preliminary results indicate that pain intensity, pain description and factors affecting the pain are similar for SAP and PDAP. Female gender, long pain duration, high pain frequency, and concurrent muscle/joint pain presented more frequently in PDAP.

  • 2.
    Allison, J. R.
    et al.
    School of Dental Sciences Faculty of Medical Sciences Newcastle University Newcastle upon Tyne UK.
    Stone, S. J.
    School of Dental Sciences Faculty of Medical Sciences Newcastle University Newcastle upon Tyne UK.
    Pigg, M.
    Malmö University, Faculty of Odontology (OD).
    The painful tooth: mechanisms, presentation and differential diagnosis of odontogenic pain2020In: Oral Surgery, ISSN 1752-2471, E-ISSN 1752-248X, Vol. 13, no 4, p. 309-320Article in journal (Refereed)
    Abstract [en]

    Pain arising for the teeth and supporting structures is a very common complaint, affecting around 9% of adults in the UK, and it can sometimes be difficult to determine the exact cause. In this narrative review, we explore the underlying neurophysiology of odontogenic pain and describe the relevance of this to clinical practise. We discuss characteristic features of pain arising from the various dentoalveolar structures and common oral disorders, and consider that non-odontogenic pain may occasionally present as toothache. As well as describing current approaches to reaching a reliable diagnosis, we also discuss some innovative techniques and potential future developments in this area. 

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  • 3.
    Alstergren, Per
    et al.
    Malmö University, Faculty of Odontology (OD).
    Pigg, Maria
    Malmö University, Faculty of Odontology (OD).
    Kopp, S.
    Clinical diagnosis of temporomandibular joint arthritis2018In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 45, no 4, p. 269-281Article in journal (Refereed)
    Abstract [en]

    Evidence-based clinical diagnostic criteria for temporomandibular joint (TMJ) arthritis are not available. To establish (i) criteria for clinical diagnosis of TMJ arthritis and (ii) clinical variables useful to determine inflammatory activity in TMJ arthritis using synovial fluid levels of inflammatory mediators as the reference standard. A calibrated examiner assessed TMJ pain, function, noise and occlusal changes in 219 TMJs (141 patients, 15 healthy individuals). TMJ synovial fluid samples were obtained with a push-pull technique using the hydroxycobalamin method and analysed for TNF, TNFsRII, IL-1, IL-1ra, IL-1sRII, IL-6 and serotonin. If any inflammatory mediator concentration exceeded normal, the TMJ was considered as arthritic. In the patient group, 71% of the joints were arthritic. Of those, 93% were painful. About 66% of the non-arthritic TMJs were painful to some degree. Intensity of TMJ resting pain and TMJ maximum opening pain, number of jaw movements causing TMJ pain and laterotrusive movement to the contralateral side significantly explained presence of arthritis (AUC 0.72, P<.001). Based on these findings, criteria for possible, probable and definite TMJ arthritis were determined. Arthritic TMJs with high inflammatory activity showed higher pain intensity on maximum mouth opening (P<.001) and higher number of painful mandibular movements (P=.004) than TMJs with low inflammatory activity. The combination TMJ pain on maximum mouth opening and Contralateral laterotrusion <8mm appears to have diagnostic value for TMJ arthritis. Among arthritic TMJs, higher TMJ pain intensity on maximum mouth opening and number of mandibular movements causing TMJ pain indicates higher inflammatory activity.

  • 4. Baad-Hansen, Lene
    et al.
    Pigg, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Elmasry Ivanovic, Susanne
    Faris, Hanan
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Drangsholt, Mark
    Svensson, Peter
    Malmö högskola, Faculty of Odontology (OD).
    Chairside intraoral qualitative somatosensory testing: reliability and comparison between patients with atypical odontalgia and healthy controls2013In: Journal of Orofacial Pain, ISSN 1064-6655, E-ISSN 1945-3396, Vol. 27, no 2, p. 165-170Article in journal (Refereed)
    Abstract [en]

    AIMS: To assess intraoral inter- and intraexaminer reliability of three qualitative measures of intraoral somatosensory function and to compare these measures between patients with atypical odontalgia (AO) and healthy controls. METHODS: Thirty-one AO patients and 47 healthy controls participated. Inter- and intraexaminer reliability was tested on a subgroup of 46 subjects (25 AO; 21 healthy). Sensitivity to touch, cold, and pinprick stimuli was evaluated on the painful gingival site and the corresponding contralateral site in AO patients, and bilaterally on the gingiva of the first maxillary premolars in controls. Patients were asked to report hypersensitivity, hyposensitivity, or normal sensitivity to stimuli on the painful site compared with the nonpainful site. Kappa values were calculated, and chi-square and Fisher's exact tests were used to compare frequencies between groups. RESULTS: Kappa values ranged between 0.63 and 0.75. The frequency of hypersensitivity to either modality was significantly higher in patients (29% to 61%) than in controls (9% to 17%) (P < .015), whereas reports of hyposensitivity were similar between groups (2% to 16%) (P > .057). Only 3.2% of the AO patients had no reports of abnormal sensitivity on any of the tests, compared with 59.6% of the healthy subjects (P < .001). CONCLUSION: Intraoral qualitative somatosensory testing can detect intraoral sensory disturbances in AO patients, and the reliability is sufficient for initial screening of orofacial somatosensory function.

  • 5. Baad-Hansen, Lene
    et al.
    Pigg, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Elmasry Ivanovic, Susanne
    Faris, Hanan
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Drangsholt, Mark
    Svensson, Peter
    Malmö högskola, Faculty of Odontology (OD).
    Chair-side intraoral somatosensory examination in patients with atypical odontalgia and healthy subjects2012Conference paper (Other academic)
    Abstract [en]

    Chair-side intraoral somatosensory examination in patients with atypical odontalgia and healthy subjects L Baad-Hansen, M Pigg, S Elmasry Ivanovic, H Faris, T List, M Drangsholt, P Svensson Aim of investigation: In patients with persistent orofacial pain, assessment of somatosensory function is recommended. A chair-side qualitative examination with good reliability revealing signs of hyper-/hyposensitivity to touch, cold and painful pinprick stimulation may be performed. The aim of this multicenter study was to compare three qualitative measures of intraoral somatosensory function between patients with atypical odontalgia (AO) and healthy subjects. Methods: 31 AO patients (6 male, 25 female; mean age: 54±13) and 47 healthy age- and sex-matched controls (15 male, 32 female: mean age: 47±12) were recruited from Malmö University (Sweden), University of Washington (USA) and Aarhus University (Denmark). In AO patients, sensitivity to touch, cold, and pinprick stimuli was evaluated on the buccal gingiva adjacent to the painful site and the corresponding contralateral ‘mirror-image’ gingival site. In healthy subjects, tests were performed bilaterally on the buccal gingiva adjacent to the first maxillary premolars. Patients were asked to report hyper-, hypo-, or normo-sensitivity/- algesia to touch, cold and painful stimuli on the painful site compared with the contralateral site; healthy subjects were asked to compare sensitivity between sides. Χ2-tests were used to analyze differences in frequency of hyper-, hyposensitivity or normosensitivity between groups. Results: The frequency of subjectively reported normosensitivity to all stimulus modalities were significantly lower in patients (23-58%) than in healthy subjects (68-91%), P<0.001. Frequency of hypersensitivity to all modalities were significantly higher in patients (29-61%) than in controls (9-17%), P<0.015, whereas reports of hyposensitivity were similar between groups (2-16%), P>0.054. Conclusion: A quick and simple chair-side evaluation of intraoral somatosensory function can detect intraoral sensory disturbances in AO patients, mainly in the form of hyper-sensitivity. These tests may be useful in the initial screening of patients with persistent orofacial pain.

  • 6. Baad-Hansen, Lene
    et al.
    Pigg, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Elmasry Ivanovic, Susanne
    Faris, Hanan
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Drangsholt, Mark
    Svensson, Peter
    Malmö högskola, Faculty of Odontology (OD).
    Reliability of chair-side intraoral somatosensory examination2012In: Journal of Dental Research, Vol. 91, no Special Issue B, article id 303Article in journal (Other academic)
  • 7. Baad-Hansen, Lene
    et al.
    Pigg, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Elmasry Ivanovic, Susanne
    Faris, Hanan
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Svensson, Peter
    Malmö högskola, Faculty of Odontology (OD).
    Drangsholt, Mark
    Intraoral somatosensory abnormalities in atypical odontalgia: a multicenter study2013In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 92, no Special Issue A, article id 1710Article in journal (Other academic)
  • 8. Baad-Hansen, Lene
    et al.
    Pigg, Maria
    Malmö högskola, Faculty of Odontology (OD).
    EĺMasry Ivanovic, Susanne
    Faris, Hanan
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Drangsholt, Mark
    Svensson, Peter
    Malmö högskola, Faculty of Odontology (OD).
    Intraoral somatosensory abnormalities in patients with atypical odontalgia: a controlled multicenter quantitative sensory testing study2013In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 154, no 8, p. 1287-1294Article in journal (Refereed)
    Abstract [en]

    Intraoral somatosensory sensitivity in patients with atypical odontalgia (AO) has not been investigated systematically according to the most recent guidelines. The aims of this study were to examine intraoral somatosensory disturbances in AO patients using healthy subjects as reference, and to evaluate the percent agreement between intraoral quantitative sensory testing (QST) and qualitative sensory testing (QualST). Forty-seven AO patients and 69 healthy control subjects were included at Universities of Washington, Malmö, and Aarhus. In AO patients, intraoral somatosensory testing was performed on the painful site, the corresponding contralateral site, and at thenar. In healthy subjects, intraoral somatosensory testing was performed bilaterally on the upper premolar gingiva and at thenar. Thirteen QST and 3 QualST parameters were evaluated at each site, z-scores were computed for AO patients based on the healthy reference material, and LossGain scores were created. Compared with control subjects, 87.3% of AO patients had QST abnormalities. The most frequent somatosensory abnormalities in AO patients were somatosensory gain with regard to painful mechanical and cold stimuli and somatosensory loss with regard to cold detection and mechanical detection. The most frequent LossGain code was L0G2 (no somatosensory loss with gain of mechanical somatosensory function) (31.9% of AO patients). Percent agreement between corresponding QST and QualST measures of thermal and mechanical sensitivity ranged between 55.6% and 70.4% in AO patients and between 71.1% and 92.1% in control subjects. In conclusion, intraoral somatosensory abnormalities were commonly detected in AO patients, and agreement between quantitative and qualitative sensory testing was good to excellent.

  • 9. Baad-Hansen, Lene
    et al.
    Pigg, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Yang, G
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Svensson, Peter
    Drangsholt, M
    Reliability of intra-oral quantitative sensory testing (QST) in patients with atypical odontalgia and healthy controls: a multicentre study2015In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 42, no 2, p. 127-135Article in journal (Refereed)
    Abstract [en]

    The reliability of comprehensive intra-oral quantitative sensory testing (QST) protocol has not been examined systematically in patients with chronic oro-facial pain. The aim of the present multicentre study was to examine test-retest and interexaminer reliability of intra-oral QST measures in terms of absolute values and z-scores as well as within-session coefficients of variation (CV) values in patients with atypical odontalgia (AO) and healthy pain-free controls. Forty-five patients with AO and 68 healthy controls were subjected to bilateral intra-oral gingival QST and unilateral extratrigeminal QST (thenar) on three occasions (twice on 1 day by two different examiners and once approximately 1 week later by one of the examiners). Intra-class correlation coefficients and kappa values for interexaminer and test-retest reliability were computed. Most of the standardised intra-oral QST measures showed fair to excellent interexaminer (9-12 of 13 measures) and test-retest (7-11 of 13 measures) reliability. Furthermore, no robust differences in reliability measures or within-session variability (CV) were detected between patients with AO and the healthy reference group. These reliability results in chronic orofacial pain patients support earlier suggestions based on data from healthy subjects that intra-oral QST is sufficiently reliable for use as a part of a comprehensive evaluation of patients with somatosensory disturbances or neuropathic pain in the trigeminal region.

  • 10. Baad-Hansen, Lene
    et al.
    Pigg, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Yang, G
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Svensson, Peter
    Malmö högskola, Faculty of Odontology (OD).
    Drangsholt, Mark
    Reliability of intraoral quantitative sensory testing (QST) in patients with atypical odontalgia and healthy controls: a multicenter study2014Conference paper (Other academic)
    Abstract [en]

    Reliability of intraoral quantitative sensory testing (QST) in patients with atypical odontalgia and healthy controls – a multicenter study The reliability of a comprehensive intraoral quantitative sensory testing (QST) protocol has not been examined systematically in patients with chronic orofacial pain. Also, the reliability of QST z-scores has not been reported. Aim of Investigation: The aim of the present multi-center study was to examine test-retest and inter-examiner reliability of intraoral QST measures in terms of absolute values and z-scores as well as within-session coefficients of variation (CV) values in patients with atypical odontalgia (AO) and healthy pain-free controls. Methods: Fourty-five AO patients and 68 healthy controls were subjected to bilateral intraoral gingival QST and unilateral extraoral QST (thenar) on three occasions (twice on one day by two different examiners and once approximately one week later by one of the examiners). Interclass correlation coefficients and kappa values for inter-examiner and test-retest reliability were computed. Results: Most of the standardized intraoral QST measures (absolute values and z-scores) showed fair to excellent inter-examiner (9-12 of 13 measures) and test-retest (7-11 of 13 measures) reliability. Furthermore, no robust differences in reliability measures or within-session variability (CV) were detected between AO patients and the healthy reference group. Conclusions: These reliability results in chronic orofacial pain patients support earlier suggestions based on data from healthy subjects that intraoral QST (absolute values as well as z-scores) is sufficiently reliable for use as a part of a comprehensive evaluation of patients with somatosensory disturbances or neuropathic pain in the trigeminal region.

  • 11. Benca, Laura
    et al.
    Naud, Jason M
    Pigg, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Baad-Hansen, Lene
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Svensson, Peter
    Malmö högskola, Faculty of Odontology (OD).
    Drangsholt, Mark
    Comparing reliability of extraoral versus intraoral trigeminal quantitative sensory testing2013In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 92, no Special Issue A, article id 2684Article in journal (Other academic)
  • 12.
    Brodén, Joséphine
    et al.
    Malmö University, Faculty of Odontology (OD). Malmö University, Foresight.
    Fransson, Helena
    Malmö University, Foresight.
    Vareman, Niklas
    Lunds universitet.
    Pigg, Maria
    Malmö University, Foresight.
    Reflection to enhance students' awareness of and comfort with uncertainty.Manuscript (preprint) (Other academic)
  • 13.
    Brodén, Joséphine
    et al.
    Department of Dental Medicine, Karolinska Institutet, Stockholm.
    Pigg, Maria
    Malmö University, Faculty of Odontology (OD). Malmö University, Foresight.
    Vareman, Niklas
    Department of Medical Ethics, Lund University.
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD). Malmö University, Foresight.
    “Experts already have the answers". A mixed methods study on dental students’ reflections on risk assessment of root filled teeth2023In: ESE Wladimir Adlivankine Research Prize, Education Prize and Original Research Abstracts, 2023, article id EP02Conference paper (Other academic)
    Abstract [en]

    Aims: Reflection on a deeper level is recognized as an important skill to learn for undergraduate students since mastering reflection can be helpful throughout their future careers. The aim with this study was to (i) examine if short structured written reflections could stimulate deep reflection among a group of dental students and (ii) explore specifically how the students reflected on clinical experience in relation to uncertainty when assessing the risk for exacerbation of apical periodontitis in root filled teeth.Methods: Short reflections were written by 52 dental students at Malmö University in 2021. All students first answered some questions associated with the risk for exacerbation of apical periodontitis in a case with a root filled tooth with a diffuse widening of the periodontal ligament space. After this, they were asked to write short reflections following prompts developed specifically to stimulate reflection. For each student, the reflections were analyzed and the level of reflection according to the 4Rs framework (Reporting/responding, Relating, Reasoning, Reconstructing) was assessed. The written content in the reflections were analyzed by a qualitative method, Systematic Text Condensation (STC). Results: Thirteen of the students (25%) reached the deepest level of reflection, Reconstructing. Sixteen students (31%), reached only the most superficial level, Report/respond. Two themes about experience and lack of experience were identified in the reflections: Theme 1 “The meaning of clinical experience” and Theme 2 “Differences and similarities”. The themes were subdivided into nine subgroups and described in more detail the relationship between experience and certainty as perceived by the students.Conclusions: A short reflection exercise stimulated deep reflection in a proportion of, but not all, dental students. The students believed that certainty comes with experience even when there is a lack of scientific evidence.

  • 14.
    Brodén, Joséphine
    et al.
    Malmö University, Faculty of Odontology (OD). Malmö University, Foresight.
    Pigg, Maria
    Malmö University, Faculty of Odontology (OD). Malmö University, Foresight.
    Vareman, Niklas
    Lunds universitet.
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD). Malmö University, Foresight.
    What is the relationship between certainty and experience?: A qualitative study on dental students’ reflections on risk assessment of root filled teeth.Manuscript (preprint) (Other academic)
  • 15. Drangsholt, Mark
    et al.
    Rei, N
    Huggins, Kimberly
    Svensson, Peter
    Malmö högskola, Faculty of Odontology (OD).
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Pigg, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Baad-Hansen, Lene
    Garson, Gayle
    Quantitative Sensory Testing of Chronic Continuous Dentoalveolar Pain2010Conference paper (Other academic)
    Abstract [en]

    Objectives: Chronic continuous dentoalveolar pain (CCDAP) is a new term for chronic pain around teeth. Quantitative sensory testing (QST) has shown promise as a tool for studying mechanisms of pain conditions. Aims: 1) compare sensory parameter values in CCDAP patients and symptom-free controls; and 2) characterize the somatosensory profile of patients with CCDAP. Methods: The German Neuropathic Pain QST protocol of 13 somatosensory function tests was adapted for intraoral use. Cases with CCDAP from tertiary care clinics were tested along with symptom-free controls. QST was performed intra-orally on symptomatic facial gingiva, asymptomatic contralateral site, and non-trigeminal site (thumb). Means and standard deviations were compared between symptomatic and asymptomatic sites within cases and with controls. Results: Interim analyses of 17 controls and 13 cases showed a mean age of 37 years for controls and 55 for cases. At the thumb, significant differences (p < 0.05) between cases/controls were apparent for pressure pain threshold (PPT) 353 vs. 453 kPa; mechanical pain threshold (MPT) 75 vs. 161 mN; and cold pain threshold (CPT) 8.4 vs. 2.8 C, all showing cases more sensitive. At the painful gingival site, significant differences between cases/controls existed for: CPT 17.4 vs. 8.1 C; HPT 44 vs. 49 C; MPT 55 vs. 154 mN; and PPT 106 vs. 172 kPa. Non-painful parameters, such as cold and warm detection threshold were generally not significantly different between cases/controls at thumb and painful gingival sites. Among cases only, comparing painful to nonpainful side, MPT was 55 vs. 96 mN; mechanical pain sensitivity 4.7 vs. 3.0; PPT 106 vs. 122 kPa, all more sensitive on the painful site. Conclusions: These results suggest that CCDAP patients are more sensitive to multiple modalities of painful stimulation at both non-trigeminal and trigeminal sites, and may be exhibiting a trigeminal neuropathy with gain in function. Grant: NIHR21DE018768.

  • 16. Edvinsson, Olivia
    et al.
    Ekelund, Johanna
    Nixdorf, Donald R
    Vase Toft, Lene
    List, Thomas
    Malmö University, Faculty of Odontology (OD).
    Pigg, Maria
    Malmö University, Faculty of Odontology (OD).
    Double-Blind Concealment Inadequate When Administering Local Anesthetic and Non-Active Control.2018In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 97, no Special Issue B, article id 0147Article in journal (Other academic)
  • 17. Engfalk, Paul
    et al.
    Pigg, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Svensson, Peter
    Malmö högskola, Faculty of Odontology (OD).
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Influence of intra- and extraoral sites and size of stimulation area on thermal detection and pain threholds. A methodological study2007In: Swedish Dental Journal, ISSN 0347-9994, Vol. 31, no 4Article in journal (Other academic)
    Abstract [en]

    Aim: This study compared cool detection thresholds, warm detection thresholds and heat pain thresholds at intra- and extraoral locations and measured the influence of spatial summation. Material and Methods: Thirty healthy individuals (15 females and 15 males), mean age 24.9 years, range 20-31 years) participated in the study. Thresholds for warm detection (WDT), cool detection (CDT) and heat pain threshold (HPT) were measured using a thermotester (MSA–Modular sensory Analyzer, Somedic). The intraoral thermode was custom-made with a 9x9mm square surface. The average of three measurements was recorded. Four intraoral sites (gingival regions 24 and 34, tip of the tongue, lower lip) and two extraoral sites (infraorbitalis, thenar) were measured in each participant. To measure spatial summation, five acrylic covers (tip areas: 0.81 cm2, 0.50 cm2, 0.28cm2, 0.125cm2, 0 cm2) were made to fit the thermode. Five measurements on the tip of the tongue were averaged for each acrylic cover. Results: Of the extraoral sites, the cold detection threshold was significantly higher and the heat pain threshold was significantly lower at the infraorbitalis than at the thenar. Of the intraoral sites, the cold detection threshold was significantly lower at the tongue than at any of the other intraoral locations; the heat pain threshold was significantly lower on the tip of the tongue than on the lower lip. Warm detection and heat pain thresholds rose slightly with increasing thermode size, and this association was more pronounced than for cold detection thresholds. Conclusion: Temperature thresholds differed significantly between several anatomic sites, and the association between size of stimulation area and temperature thresholds was weak.

  • 18.
    Fransson, Helena
    et al.
    Malmö University, Faculty of Odontology (OD).
    Bjørndal, Lars
    Odont inst, Köpenhamns universitet.
    Dawson, Victoria
    Malmö University, Faculty of Odontology (OD).
    Frisk, Fredrik
    Odont inst, Folktandvården, Region Jönköpings län..
    Kvist, Thomas
    Inst för odont, Sahlgrenska akademin, Göteborgs universitet.
    Markvart, Merete
    Odont inst, Köpen-hamns universitet.
    Pigg, Maria
    Malmö University, Faculty of Odontology (OD).
    Wigsten, Emma
    Inst för odont, Sahlgrenska akademin, Göteborgs universitet.
    EndoReCo banar väg för ökad kunskap och akademisk meritering2022In: Tandläkartidningen, ISSN 0039-6982, Vol. 114, no 12, p. 46-52Article in journal (Refereed)
    Abstract [en]

    Collaboration is essential to focus on the urgent research questions and to fill knowledge gaps in Odontology. Larger research consortiums have a better potential to utilize different competencies and other resources, and consequently increase research output. Bigger, more complex projects can be undertaken, which in turn improves the potential to attract external funding. Collaboration with other institutions also facilitates academic meriting, which is highly desirable from a Swedish perspective, especially since the number of senior researchers with formal competence to supervise doctoral research projects is lower than ever before. Here, we present EndoReCo, a Scandinavian research network in Endodontics initiated a decade ago with these very opportunities in mind. The article describes the results of this collaboration to date, highlights the success factors and difficulties, and aims to inspire others to similar collaborations in other disciplines.

  • 19.
    Havsed, Kristian
    et al.
    Malmö University, Faculty of Odontology (OD). Department of Pediatric Dentistry, Institute for Postgraduate Dental Education, Jönköping, Sweden; Centre for Oral Health, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
    Hänsel Petersson, Gunnel
    Malmö University, Faculty of Odontology (OD).
    Isberg, Per-Erik
    Department of Statistics, Lund University, Lund, Sweden.
    Pigg, Maria
    Malmö University, Faculty of Odontology (OD). Malmö University, Foresight.
    Svensäter, Gunnel
    Malmö University, Faculty of Odontology (OD).
    Rohlin, Madeleine
    Malmö University, Faculty of Odontology (OD).
    Multivariable prediction models of caries increment: a systematic review and critical appraisal.2023In: Systematic Reviews, E-ISSN 2046-4053, Vol. 12, no 1, article id 202Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Multivariable prediction models are used in oral health care to identify individuals with an increased likelihood of caries increment. The outcomes of the models should help to manage individualized interventions and to determine the periodicity of service. The objective was to review and critically appraise studies of multivariable prediction models of caries increment.

    METHODS: Longitudinal studies that developed or validated prediction models of caries and expressed caries increment as a function of at least three predictors were included. PubMed, Cochrane Library, and Web of Science supplemented with reference lists of included studies were searched. Two reviewers independently extracted data using CHARMS (Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies) and assessed risk of bias and concern regarding applicability using PROBAST (Prediction model Risk Of Bias ASessment Tool). Predictors were analysed and model performance was recalculated as estimated positive (LR +) and negative likelihood ratios (LR -) based on sensitivity and specificity presented in the studies included.

    RESULTS: Among the 765 reports identified, 21 studies providing 66 prediction models fulfilled the inclusion criteria. Over 150 candidate predictors were considered, and 31 predictors remained in studies of final developmental models: caries experience, mutans streptococci in saliva, fluoride supplements, and visible dental plaque being the most common predictors. Predictive performances varied, providing LR + and LR - ranges of 0.78-10.3 and 0.0-1.1, respectively. Only four models of coronal caries and one root caries model scored LR + values of at least 5. All studies were assessed as having high risk of bias, generally due to insufficient number of outcomes in relation to candidate predictors and considerable uncertainty regarding predictor thresholds and measurements. Concern regarding applicability was low overall.

    CONCLUSIONS: The review calls attention to several methodological deficiencies and the significant heterogeneity observed across the studies ruled out meta-analyses. Flawed or distorted study estimates lead to uncertainty about the prediction, which limits the models' usefulness in clinical decision-making. The modest performance of most models implies that alternative predictors should be considered, such as bacteria with acid tolerant properties.

    TRIAL REGISTRATION: PROSPERO CRD#152,467 April 28, 2020.

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  • 20. Iordanidou Mojir, Katerina
    et al.
    Pigg, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Svensson, Peter
    Malmö högskola, Faculty of Odontology (OD).
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Reliability and validity of punctuate pain thresholds and self-reported pain2013In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 92, no Special Issue A, article id 2679Article in journal (Other academic)
  • 21. Jonsson Sjögren, Jakob
    et al.
    Kvist, Thomas
    Eliasson, Alf
    EndoReCo,
    Pigg, Maria
    Malmö University, Faculty of Odontology (OD).
    The frequency and characteristics of pain and discomfort associated with root filled teeth: A practice based study.2019In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 52, no 9, p. 1264-1273Article in journal (Refereed)
    Abstract [en]

    AIM: To (1) investigate the frequency and characteristics of pain and discomfort associated with root filled teeth in adult patients regularly attending the Public Dental Service in Örebro County, Sweden; (2) assess the association between symptoms and clinical and radiographic findings, and (3) explore the impact of pain and discomfort from root filled teeth on daily life. METHODOLOGY: Patient records of adult patients (> 20 years) scheduled for routine check-ups in April 2015 were screened to identify individuals with root filled teeth; all patients with >1 root filled tooth were asked to participate. The examination comprised clinical and radiographic examinations and questionnaires on general health, on pain symptoms from root filled teeth, and on the impact of pain on daily activities. In a general estimation equation (GEE), examination findings and patient-related factors were independently analysed in relation to the outcome "presence of pain". RESULTS: In total 550 patients with 1 256 root filled teeth participated. Fifty-three patients (9.6%) experienced pain or discomfort from 62 (4.9%) root filled teeth. Lower age, percussion tenderness and apical tenderness were significantly associated with pain (P > 0.001-P=0.044). The average pain intensity was 2.1 on (0-10) Numeric Rating Scale, and average duration was 28.4 months. The impact on daily life was low. CONCLUSIONS: On average, pain associated with root filled teeth was of mild intensity, >2 years of duration and had low impact on daily life. Although the significantly associated clinical findings may indicate apical periodontitis as the most probable explanation in some teeth, the origin of pain from root filled teeth remains partly unexplained.

  • 22.
    Jonsson Sjögren, Jakob
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Kvist, Thomas
    Eliasson, Alf
    Pigg, Maria
    Malmö högskola, Faculty of Odontology (OD).
    The Prevalence of Pain and Discomfort from Root-Filled Teeth2017In: Journal of Dental Research, no Special Issue AArticle in journal (Other academic)
  • 23.
    Jonsson Sjögren, Jakob
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Pigg, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Kvist, Thomas
    Eliasson, Alf
    EndoReCo,
    Pain and discomfort from root-filled teeth: Aspects of prevalence and characteristics2017In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 50, no S 1, p. 47-47, article id R146Article in journal (Other academic)
    Abstract [en]

    Aim The aim was to examine the prevalence and characteristics of pain and discomfort from root-filled teeth in an adult Swedish population regularly attending dental care. A further aim was to examine if symptoms could be related to (i) periapical radiographic appearance and (ii) clinical findings. Methodology This cross-sectional observational study screened all adult patients scheduled for routine check-up in the public dental service, Örebro County, Sweden in April 2015. All (798) individuals with at least one root-filled tooth were asked to participate. The examination included (i) clinical examination, (ii) radiographic examination (intraoral periapical images), (iii) interviewer-assisted questionnaire covering general health and presence and characteristics of pain. Descriptive statistics were performed and Fisher’s exact test analysed correlations. Results 549 patients with 1256 root-filled teeth participated (292 women, 257 men; mean age 61.1 years, range 20–94). 55 (10.0%) of the patients experienced pain or discomfort from at least one root-filled tooth. On tooth level, 66 (5.3%) of all root-filled teeth were symptomatic. The average pain intensity was 2.2±1.9 on a 0–10 Numeric Rating Scale, and mean pain duration was 32.6 months. The pain was continuous for 21.3%, recurrent for 44.3%, and occasional for 34.4% of the teeth, and the teeth had been painful on average 9.6 of the last 30 days. Apical radiolucency was recorded at 264 (21.6%) of the root-filled teeth. Symptoms were significantly associated with presence of radiolucency (P=0.004), sinus tract (P=0.023), and pocket depth >5mm (P=0.038). Conclusions In the examined population, one in ten adults with a root-filled tooth experienced pain or discomfort associated with this tooth. The pain was generally of low intensity and long lasting. In most cases, the patient experienced recurrent or occasional pain, but one in five with painful teeth had continuous pain.

  • 24.
    List, Thomas
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Mojir, Katerina
    Svensson, Peter
    Malmö högskola, Faculty of Odontology (OD).
    Pigg, Maria
    Malmö högskola, Faculty of Odontology (OD).
    A new protocol to evaluate the effect of topical anesthesia2014In: Anesthesia Progress, ISSN 0003-3006, E-ISSN 1878-7177, Vol. 61, no 4, p. 135-144Article in journal (Refereed)
    Abstract [en]

    This double-blind, placebo-controlled, randomized cross-over clinical experimental study tested the reliability, validity, and sensitivity to change of punctuate pain thresholds and self-reported pain on needle penetration. Female subjects without orofacial pain were tested in 2 sessions at 1- to 2-week intervals. The test site was the mucobuccal fold adjacent to the first upper right premolar. Active lidocaine hydrochloride 2% (Dynexan) or placebo gel was applied for 5 minutes, and sensory testing was performed before and after application. The standardized quantitative sensory test protocol included mechanical pain threshold (MPT), pressure pain threshold (PPT), mechanical pain sensitivity (MPS), and needle penetration sensitivity (NPS) assessments. Twenty-nine subjects, mean (SD) age 29.0 (10.2) years, completed the study. Test-retest reliability intraclass correlation coefficient at 10-minute intervals between examinations was MPT 0.69, PPT 0.79, MPS 0.72, and NPS 0.86. A high correlation was found between NPS and MPS (r = 0.84; P < .001), whereas NPS and PPT were not significantly correlated. The study found good to excellent test-retest reliability for all measures. None of the sensory measures detected changes in sensitivity following lidocaine 2% or placebo gel. Electronic von Frey assessments of MPT/MPS on oral mucosa have good validity.

  • 25.
    Markvart, M
    et al.
    University of Copenhagen, Denmark.
    Tibbelin, N
    Specialist Clinic for Endodontics, Public Dental Service, Lund,.
    Pigg, Maria
    Malmö University, Faculty of Odontology (OD).
    EndoReCo,
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD). University of Gothenburg.
    Frequency of additional treatments in relation to the number of root filled canals in molar teeth in the Swedish adult population2021In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 54, no 6, p. 826-833Article in journal (Refereed)
    Abstract [en]

    AIM: To investigate the 5-year frequency of additional treatments in relation to the number of reported root filled canals in molar teeth in Sweden.

    METHODOLOGY: The cohort included first and second molars in adult individuals who were registered with a root filling performed in 2009. Treatment codes corresponding to root fillings of teeth with from one up to four root filled canals were identified in the Swedish Social Insurance Agency database. The studied additional treatments were extraction, non-surgical root canal retreatment and endodontic surgery during the subsequent 5 years, identified by corresponding codes for these treatments registered on these specific teeth. Differences in the frequency of additional treatments based on the number of root filled canals were analysed using Chi-square test, and considered statistically significant at p<0.05.

    RESULTS: In 2009, root fillings on a first or second molar tooth were registered in 100 720 individuals. The study included 32 901 maxillary first molars (6.4% with four root filled canals), 12 763 maxillary second molars (3.3% with four root filled canals), 37 703 mandibular first molars (19.2% with four root filled canals) and 17 353 mandibular second molars (3.7% with four root filled canals). The total frequency additional treatments was 14.3% (n=14 425) during the 5-year observational period. Additional treatments were more frequent in teeth with 1-3 root filled canals compared to teeth with four root filled canals for maxillary first molars (15.2% vs. 12.7%, p=0.002), maxillary second molars (13.8% vs. 9.1%, p=0.007) and mandibular first molars (14.0% vs. 10.7%, p<0.001) but not mandibular second molars (15.6% vs. 13.7%, p=0.200).

    CONCLUSIONS: Over 5 years, 85.7% of the included teeth were not registered with any additional treatments. Maxillary first and second molars and mandibular first molar teeth had a greater frequency of additional treatments when ≤3 root canals were root filled compared to 4 canals.

  • 26.
    May, Arne
    et al.
    Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
    Benoliel, Rafael
    Rutgers School of Dentistry, New Jersey, USA.
    Imamura, Yoshiki
    Department of Oral Medicine, School of Dentistry, Nihon University Tokyo, Tokyo, Japan.
    Pigg, Maria
    Malmö University, Faculty of Odontology (OD).
    Baad-Hansen, Lene
    Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.
    Svensson, Peter
    Malmö University, Faculty of Odontology (OD). Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.
    Hoffmann, Jan
    Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology & Neurosciences, King's College London, London, UK; Department of Neurology, King's College London, London, UK.
    Orofacial pain for clinicians: A review of constant and attack-like facial pain syndromes2023In: Cephalalgia, ISSN 0333-1024, E-ISSN 1468-2982, Vol. 43, no 8, article id 3331024231187160Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Primary headache syndromes such as migraine are among the most common neurological syndromes. Chronic facial pain syndromes of non-odontogenic cause are less well known to neurologists despite being highly disabling. Given the pain localization, these patients often consult dentists first who may conduct unnecessary dental interventions even if a dental cause is not identified. Once it becomes clear that dental modalities have no effect on the pain, patients may be referred to another dentist or orofacial pain specialist, and later to a neurologist. Unfortunately, neurologists are also often not familiar with chronic orofacial pain syndromes although they share the neural system, i.e., trigeminal nerve and central processing areas for headache disorders.

    CONCLUSION: In essence, three broad groups of orofacial pain patients are important for clinicians: (i) Attack-like orofacial pain conditions, which encompass neuralgias of the cranial nerves and less well-known facial variants of primary headache syndromes; (ii) persistent orofacial pain disorders, including neuropathic pain and persistent idiopathic facial/dentoalveolar pain; and (iii) other differential diagnostically relevant orofacial pain conditions encountered by clinicians such as painful temporomandibular disorders, bruxism, sinus pain, dental pain, and others which may interfere (trigger) and overlap with headache. It is rewarding to know and recognize the clinical picture of these facial pain syndromes, given that, just like for headache, an internationally accepted classification system has been published and many of these syndromes can be treated with medications generally used by neurologists for other pain syndromes.

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  • 27. Mikkilä, Hanna
    et al.
    Alijagic, Vedrana
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Pigg, Maria
    Malmö högskola, Faculty of Odontology (OD).
    A comparison of two different methods to measure pressure pain thresholds: An experimental study2017Conference paper (Other academic)
    Abstract [en]

    Introduction: Assessment of somatosensory function is recommended in orofacial pain investigations. Quantitative Sensory Testing (QST) is a comprehensive method in which pressure pain threshold (PPT) measurement is included. PPT is usually obtained with a conventional Algometer Type II. A new computer-controlled and potentially more user-friendly algometer, the SENSEBox, could replace the conventional device provided that threshold values and other properties are similar between devices. Aim: Compare two algometers regarding absolute PPT, variability, time, and test-retest-reliability. Materials and methods: PPT was measured with both devices on thenar, masseter muscle and gingiva (upper premolar region) in twenty healthy adults. For each anatomic site and device, the mean value of three registrations was calculated. Paired t-test and Wilcoxon sign-rank test compared mean PPT, variability and time duration. Intraclass Correlation Coefficient (ICC) analyzed test-retest reliability. Results: The SENSEBox showed overall lower PPTs (p<0.05). No significant differences in variability and time duration were found (p>0.05). Both devices showed very good to excellent test-retest-reliability (ICC 0.75–0.88) for thenar and masseter. On gingiva, Algometer Type II showed poor (ICC 0.38) and SENSEBox good reliability (ICC 0.43). Conclusion: The Algometer Type II and SENSEBox are not readily interchangeable in PPT assessment and QST in orofacial pain investigations.

  • 28.
    Nagendrababu, V
    et al.
    Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE.
    Abbott, P
    UWA Dental School, University of Western Australia, Nedlands, Australia.
    Duncan, H F
    Division of Restorative Dentistry, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland.
    Fouad, A F
    School of Dentistry, UAB, The University of Alabama at Birmingham, Birmingham, Alabama, USA.
    Kruse, C
    Section of Oral Radiology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.
    Patel, S
    The Faculty of Dentistry, Oral and Craniofacial Sciences, Kings' College London, London, UK.
    Pigg, Maria
    Malmö University, Faculty of Odontology (OD).
    Rechenberg, D K
    Department of Conservative and Preventive Dentistry, University of Zürich, Zürich, Switzerland.
    Dummer, P M H
    School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.
    Preferred Reporting Items for Diagnostic Accuracy Studies in Endodontics (PRIDASE) guidelines: a development protocol2021In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 54, no 7, p. 1051-1055Article, review/survey (Refereed)
    Abstract [en]

    Diagnostic accuracy studies play an important role in informing clinical practice and patient management, by evaluating the ability of diagnostic testing and imaging to identify the presence or absence of a disease or condition. These studies compare the relative diagnostic strength of the test or device with a reference standard, therefore, guiding clinical decisions on the reliability of the test, the need for further tests, and whether to monitor or treat a particular condition. Inadequate and incomplete reporting of diagnostic accuracy studies can disguise methodological deficiencies and ultimately result in study bias and the inability to translate research findings into daily clinical practice. The Preferred Reporting Items for Diagnostic Accuracy Studies in Endodontics (PRIDASE) guidelines are being developed in order to improve the accuracy, transparency, completeness and reproducibility of diagnostic accuracy studies in the speciality of Endodontology. The aim of this paper is to report the process used to develop the PRIDASE guidelines based on a well-established consensus process. The project leaders (PD, VN) formed a steering committee of nine members (PD, VN, PA, AF, DR, SP, CK, MP, HD) to oversee and manage the project. The PRIDASE steering committee will develop the initial draft of the PRIDASE guidelines by adapting and modifying the Standards for Reporting of Diagnostic Accuracy Studies (STARD) 2015 guidelines, adding new items related specifically to the nature of Endodontics and incorporate the Clinical and Laboratory Images in Publication (CLIP) principles. The initial guidelines will consist of a series of domains and individual items and will be validated by the members of a PRIDASE Delphi Group (PDG) consisting of a minimum of 30 individuals who will evaluate independently the individual items based on two parameters: 'clarity' using a dichotomous scoring (yes/no) and 'suitability' for inclusion using a 9-point Likert Scale. The scores awarded by each member and any suggestions for improvement will be shared with the PDG to inform an iterative process that will result in a series of items that are clear and suitable for inclusion in the new PRIDASE guidelines. Once the PDG has completed its work, the steering committee will create a PRIDASE Meeting Group (PMG) of 20 individuals from around the world. Members of the PDG will be eligible to be the part of PMG. The draft guidelines and flowchart approved by the PDG will then be presented for further validation and agreement by the PMG. As a result of these discussions, the PRIDASE guidelines will be finalized and then disseminated to relevant stakeholders through publications and via the Preferred Reporting Items for study Designs in Endodontology (PRIDE) website (http://pride-endodonticguidelines.org). Periodic updates to the PRIDASE guidelines will be made based on feedback from stakeholders and end-users.

  • 29. Nagendrababu, V
    et al.
    Duncan, H F
    Bjørndal, L
    Kvist, T
    Priya, E
    Jayaraman, J
    Pulikkotil, S J
    Pigg, Maria
    Malmö University, Faculty of Odontology (OD).
    Rechenberg, D K
    Vaeth, M
    Dummer, Pmh
    PRIRATE 2020 guidelines for reporting randomized trials in Endodontics: a consensus-based development2020In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 53, no 6, p. 764-773Article in journal (Refereed)
    Abstract [en]

    September 2019 in Vienna, Austria. A total of 21 individuals from across the globe and four steering committee members (PD, VN, HD, LB) attended the meeting. As a consequence of the discussions, the guidelines were modified and then piloted by several authors whilst writing a manuscript. The PRIRATE 2020 guidelines contain a checklist consisting of 11 sections and 58 individual items as well as a flowchart, considered essential for authors to include when writing manuscripts for randomized clinical trials in Endodontics.

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  • 30. Nagendrababu, V.
    et al.
    Duncan, H. F.
    Fouad, A. F.
    Kirkevang, L. L.
    Parashos, P.
    Pigg, Maria
    Malmö University, Faculty of Odontology (OD).
    Vaeth, M.
    Jayaraman, J.
    Dummer, P. M. H.
    Preferred Reporting items for OBservational studies in Endodontics (PROBE) guidelines: a development protocol2020In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 53, no 9, p. 1199-1203Article in journal (Refereed)
    Abstract [en]

    Observational studies have a significant role in establishing the prevalence and incidence of diseases in populations, as well as determining the benefits and risks associated with health-related interventions. Observational studies principally encompass cohort, case-control, case series and cross-sectional designs. Inadequate reporting of observational studies is likely to have a negative impact on decision-making in day-to-day clinical practice; however, no reporting guidelines have been published for observational studies in Endodontics. The aim of this project is to develop reporting guidelines for authors when creating manuscripts describing observational studies in the field of Endodontology in an attempt to improve the quality of publications. The new guidelines for observational studies will be named: 'Preferred Reporting items for OBservational studies in Endodontics (PROBE)'. A steering committee was formed by the project leaders (PD, VN) to develop the guidelines through a five-phase consensus process. The steering committee will review and adapt items from the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statement and the Clinical and Laboratory Images in Publications (CLIP) principles, as well as identify new items that add value to Endodontics. The steering committee will create a PROBE Delphi Group (PDG), consisting of 30 members across the globe to review and refine the draft checklist items and flowchart. The items will be assessed by the PDG on a nine-point Likert scale for relevance and inclusion. The agreed items will then be discussed by a PROBE Face-to-Face meeting group (PFMG) made up of 20 individuals to further refine the guidelines. After receiving feedback from the PFMG, the steering committee will pilot and finalize the guidelines. The approved PROBE guidelines will be disseminated through publication in relevant journals, and be presented at national and international conferences. The PROBE checklist and flowchart will be available and downloadable from the Preferred Reporting Items for study Designs in Endodontics (PRIDE) website: . The PROBE steering committee encourages clinicians, researchers, editors and peer reviewers to provide feedback on the PROBE guidelines to inform the steering group when the guidelines are updated.

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  • 31.
    Nagendrababu, Venkateshbabu
    et al.
    Department of Preventive and Restorative Dentistry University of Sharjah Sharjah UAE.
    Duncan, Henry F.
    Division of Restorative Dentistry Dublin Dental University Hospital, Trinity College Dublin Dublin Ireland.
    Fouad, Ashraf F.
    Department of Endodontics, School of Dentistry The University of Alabama at Birmingham Birmingham Alabama USA.
    Kirkevang, Lise‐Lotte
    Department of Dentistry and Oral Health Aarhus University Aarhus Denmark.
    Parashos, Peter
    Melbourne Dental School University of Melbourne Melbourne Victoria Australia.
    Pigg, Maria
    Malmö University, Faculty of Odontology (OD).
    Væth, Michael
    Department of Public Health Aarhus University Aarhus Denmark.
    Jayaraman, Jayakumar
    Department of Pediatric Dentistry Virginia Commonwealth University Richmond USA.
    Suresh, Nandini
    Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Ammal Dental College and Hospital Meenakshi Academy of Higher Education and Research (MAHER) Chennai India.
    Arias, Ana
    Department of Conservative and Prosthetic Dentistry, School of Dentistry Complutense University Madrid Spain.
    Wigsten, Emma
    Department of Endodontology, Institute of Odontology, The Sahlgrenska Academy University of Gothenburg Gothenburg Sweden.
    Dummer, Paul M. H.
    School of Dentistry, College of Biomedical and Life Sciences Cardiff University Cardiff UK.
    PROBE 2023 guidelines for reporting observational studies in Endodontics: A consensus‐based development study2023In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 56, no 3, p. 308-317Article in journal (Refereed)
    Abstract [en]

    Observational studies are non-interventional studies that establish the prevalence and incidence of conditions or diseases in populations or analyse the relationship between health status and other variables. They also facilitate the development of specific research questions for future randomized trials or to answer important scientific questions when trials are not possible to carry out. This article outlines the previously documented consensus-based approach by which the Preferred Reporting items for Observational studies in Endodontics (PROBE) 2023 guidelines were developed. A steering committee of nine members was formed, including the project leaders (PD, VN). The steering committee developed an initial checklist by combining and adapting items from the STrengthening the Reporting of Observational studies in Epidemiology (STROBE) checklist and the Clinical and Laboratory Images in Publications (CLIP) principles, as well as adding several new items specifically for the specialty of Endodontics. The steering committee then established a PROBE Delphi Group (PDG) and a PROBE Online Meeting Group (POMG) to obtain expert input and feedback on the preliminary draft checklist. The PDG members participated in an online Delphi process to reach consensus on the clarity and suitability of the items present in the PROBE checklist. The POMG then held detailed discussions on the PROBE checklist generated through the online Delphi process. This online meeting was held via the Zoom platform on 7th October 2022. Following this meeting, the steering committee revised the PROBE checklist, which was piloted by several authors when preparing a manuscript describing an observational study for publication. The PROBE 2023 checklist consists of 11 sections and 58 items. Authors are now encouraged to adopt the PROBE 2023 guidelines, which will improve the overall reporting quality of observational studies in Endodontics. The PROBE 2023 checklist is freely available and can be downloaded from the PRIDE website (https://pride-endodonticguidelines.org/probe/).

  • 32.
    Nagendrababu, Venkateshbabu
    et al.
    Department of Preventive and Restorative Dentistry University of Sharjah Sharjah UAE.
    Duncan, Henry F.
    Division of Restorative Dentistry, Dublin Dental University Hospital Trinity College Dublin Dublin Ireland.
    Fouad, Ashraf F.
    Department of Endodontics, School of Dentistry The University of Alabama at Birmingham Birmingham USA.
    Kirkevang, Lise‐Lotte
    Department of Dentistry and Oral Health Aarhus University Aarhus Denmark.
    Parashos, Peter
    Melbourne Dental School University of Melbourne Melbourne Victoria Australia.
    Pigg, Maria
    Malmö University, Faculty of Odontology (OD).
    Væth, Michael
    Department of Public Health Aarhus University Aarhus Denmark.
    Jayaraman, Jayakumar
    Department of Pediatric Dentistry Virginia Commonwealth University Richmond Virginia USA.
    Suresh, Nandini
    Faculty of Dentistry, Department of Conservative Dentistry and Endodontics Meenakshi Ammal Dental College and Hospital Meenakshi Academy of Higher Education and Research (MAHER) Tamilnadu India.
    Jakovljevic, Aleksandar
    Department of Pathophysiology, School of Dental Medicine University of Belgrade Serbia.
    Dummer, Paul M. H.
    School of Dentistry, College of Biomedical and Life Sciences Cardiff University Cardiff UK.
    PROBE 2023 guidelines for reporting observational studies in endodontics: explanation and elaboration2023In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 56, no 6, p. 652-685Article in journal (Refereed)
    Abstract [en]

    Observational studies play a critical role in evaluating the prevalence and incidence of conditions or diseases in populations as well as in defining the benefits and potential hazards of health-related interventions. There are currently no reporting guidelines for observational studies in the field of Endodontics. The Preferred Reporting Items for study Designs in Endodontology (PRIDE) team have developed and published new reporting guidelines for observational-based studies called the “Preferred Reporting items for OBservational studies in Endodontics (PROBE) 2023” guidelines. The PROBE 2023 guidelines were developed exclusively for the specialty of Endodontics by integrating and adapting the “STrengthening the Reporting of OBservational studies in Epidemiology (STROBE)” checklist and the “Clinical and Laboratory Images in Publications (CLIP)” principles. The recommendations of the Guidance for Developers of Health Research Reporting Guidelines were adhered to throughout the process of developing the guidelines. The purpose of this document is to serve as a guide for authors by providing an explanation for each of the items in the PROBE 2023 checklist along with relevant examples from the literature. The document also offers advice to authors on how they can address each item in their manuscript before submission to a journal. The PROBE 2023 checklist is freely accessible and downloadable from the Preferred Reporting Items for study Designs in Endodontology (PRIDE) website (http://pride-endodonticguidelines.org/probe/).

  • 33. Närhi, Matti
    et al.
    Bjørndal, Lars
    Pigg, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Fristad, Inge
    Rethnam Haug, Sivakami
    Acute dental pain I: pulpal and dentinal pain2016In: Tandlægebladet, ISSN 0039-9353, Vol. 120, no 2, p. 110-119Article, review/survey (Refereed)
    Abstract [en]

    The specialized anatomy of the pulp-dentin complex and the dense, predominantly noci- ceptive pulpal innervation from the trigeminal nerve explains the variety of pain sensations from this organ. Brief, sharp pain is typical of A-fibre-mediated pain, while long-lasting, dull/aching pain indi- cates C-fibre involvement. A-fibres react to cold or mechanical stimuli, such as cold drinks or toothbrushing, whereas C-fibres are mainly activated by inflammatory mediators. Thus, lin- gering pain suggests presence of irreversible pulpal inflammation. During pulpitis, structural changes of the pu pal nerves (sprouting) occur and neuropeptide release triggers an immune response; neurogenic inflammation. Pain sensations during pul- pitis can range from hypersensitivity to thermal stimuli to severe throbbing. There might also be aching pain, possibly referred and often difficult to localize. Thus, diagnosis is challenging for the clinician. Surface biofilm amplifies hypersensitivity of exposed dentin surfaces because irritants reach the pulp through open dentin tubules, producing inflammation. Removing the biofilm reduces dentin hypersensitivity, but supplemental treatment, aiming to reduce dentin permeability, is often necessary. Caries removal and filling therapy are adequate measures during reversible pulpitis if the pulp has maintained its ability to distance itself from the bacterial assault by producing reparative dentin. However, endodontic therapy is necessary when pulpitis has reached an irreversible stage.

  • 34. Närhi, Matti
    et al.
    Bjørndal, Lars
    Pigg, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Fristad, Inge
    Retnam Haug, Sivakami
    Akut tandvärk I: Pulpasmärta och dentinsmärta2016In: Tandläkartidningen, ISSN 0039-6982, Vol. 108, no 1, p. 64-71Article, review/survey (Refereed)
    Abstract [en]

    The specialized anatomy of the pulp-dentin complex and the dense, predominantly nociceptive pulpal innervation from the trigeminal nerve, explains the variety of pain sensations from this organ. Brief, sharp pain is typical of A-fibermediated pain, whilst long-lasting, dull/aching pain indicates C- fiber involvement. A-fibers react to cold or mechanical stimuli, such as cold drinks or toothbrushing, whereas C-fibers are mainly activated by inflammatory mediators. Thus, lingering pain suggests the presence of irreversible pulpal inflammation. During pulpitis, structural changes of the pulpal nerves (sprouting) occur and neuropeptide release triggers an immune response; neurogenic inflammation. Pain sensations during pulpitis can range from hypersensitivity to thermal stimuli to severe throbbing, or aching pains that can be referred and often diffcult to localize making diagnosis a challenging situation for the clinician. The surface biofilm amplifies hypersensitivity of exposed dentin surfaces because irritants reach the pulp through open dentin tubules, producing inflammation. Removing the biofilm reduces dentin hypersensitivity but supplemental treatment aimed at reducing dentin permeability, is often necessary. Caries removal and lling therapy is adequate during reversible pulpitis if the pulp has maintained its ability to distance itself from the bacterial assault by producing reparative dentin. However, endodontic therapy is necessary when pulpitis has reached an irreversible stage.

  • 35.
    Olsson, Sara R
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Pigg, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Isberg, Per-Erik
    Fransson, Helena
    Malmö högskola, Faculty of Odontology (OD).
    Demographic factors in the choice of coronal restoration after root canal treatment in the Swedish adult population2017In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 50, no S1, p. 33-33, article id R096Article in journal (Other academic)
    Abstract [en]

    Aim: To compare demographic characteristics between individuals choosing an indirect coronal restoration (crown, inlay/onlay) and individuals receiving other restorations after completion of a root filling. The hypothesis was that there are demographic differences for individuals who chose an indirect and those who chose another coronal restoration after root canal treatment. Methodology: This was a registry study of a cohort consisting of all root filled upper first molars that were reported to the tax-funded Swedish Social Insurance Agency (SSIA) during 2009. The root filled teeth were identified by tooth position 16 and 26, and by specific registry codes applied to root fillings. After registration of the root filling, any subsequent coronal restorations within two years was identified. The study group consisted of individuals registered with a root filling followed by an indirect coronal restoration and the control group was the remaining individuals with a root-filled tooth and a direct coronal restoration or no registration of any coronal restoration. Data on nationality, disposable income, educational level, civil status, age and gender were received from Statistics Sweden or SSIA. Chi-square test, t-test and logistic regression compared groups. P<0.05 was considered statistically significant. Results: 7 806 individuals (21.9%) received an indirect coronal restoration and 27 886 individuals (78.1%) comprised the control group. All demographic variables but gender and nationality differed significantly between groups A significantly larger proportion of individuals in the study group had higher education, higher disposable income, were older and were less likely to be living on their own. Conclusions: The identified demographic differences between individuals having their newly root filled teeth restored with an indirect restoration compared to those receiving other restorations indicate that the tax-funded Swedish dental insurance fails to provide dental care on equal terms for Swedish citizens.

  • 36.
    Olsson, Sara R
    et al.
    Malmö University, Faculty of Odontology (OD).
    Pigg, Maria
    Malmö University, Faculty of Odontology (OD).
    Isberg, Per-Erik
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD).
    Demographic factors in the choice of coronal restoration after root canal treatment in the Swedish adult population.2019In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 46, no 1, p. 58-64Article in journal (Refereed)
  • 37.
    Pigg, Maria
    Malmö högskola, Faculty of Odontology (OD).
    Chronic intraoral pain - assessment of diagnostic methods and prognosis2011Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall goal of this thesis was to broaden our knowledge of chronic intraoral pain. The research questions were:•What methods can be used to differentiate inflammatory, odontogenic tooth pain from pain that presents as toothache but is non-odontogenic in origin?•What is the prognosis of chronic tooth pain of non-odontogenic origin, and which factors affect the prognosis?Atypical odontalgia (AO) is a relatively rare but severe and chronic pain condition affecting the dentoalveolar region. Recent research indicates that the origin is peripheral nerve damage: neuropathic pain. The condition presents as tooth pain and is challenging to dentists because it is difficult to distinguish from ordinary toothache due to inflammation or infection. AO is of interest to the pain community because it shares many characteristics with other chronic pain conditions, and pain perpetuation mechanisms are likely to be similar. An AO diagnosis is made after a comprehensive examination and assessment of patients’ self-reported characteristics: the pain history. Traditional dental diagnostic methods do not appear to suffice, since many patients report repeated care-seeking and numerous treatment efforts with little or no pain relief. Developing methods that are useful in the clinical setting is a prerequisite for a correct diagnosis and adequate treatment decisions.Quantitative sensory testing (QST) is used to assess sensory function on skin when nerve damage or disease is suspected. A variety of stimuli has been used to examine the percep¬tion of, for example, touch, temperature (painful and non-painful), vibration, pinprick pain, and pressure pain. To detect sensory abnormalities and nerve damage in the oral cavity, the same methods may be possible to use.Study I examined properties of thermal thresholds in and around the mouth in 30 pain-free subjects: the influence of measurement location and stimulation area size on threshold levels, and time variability of thresholds. Thresholds for cold, warmth and painful heat were measured in four intraoral and two extraoral sites. Measurements were repeated 3 times over 6 weeks, using four sizes of stimulation area (0.125–0.81 cm2). The threshold levels were highly dependent on location but less dependent on measuring probe size and time variability was small, and this knowledge is important for the interpretation of QST results.Study II applied a recently developed standardized QST examination protocol (intended for use on skin) inside the oral cavity. Two trained examiners evaluated 21 pain-free subjects on three occasions over 1–3 weeks, at four sites—three intraoral and one extraoral. Most tests had acceptable reliability and the original test instruments and techniques could be applied intraorally with only minor adjustments. Study III examined the value of cone-beam computed tomography (CBCT) in pain investigations. Twenty patients with AO and 5 with symptomatic apical periodontitis (inflammatory tooth pain) participated. The results indicate that when AO is suspected, addition of CBCT can improve the diagnostic certainty compared to sole use of periapical and panoramic radiographs, especially because of the superior ability of CBCT to exclude inflammation as the pain cause.Study IV assessed the long-term prognosis of AO, and analyzed potential outcome predictors.. A comprehensive questionnaire including validated and reliable instruments was used to gather data on patient and pain charac¬teristics and pain consequences from 37 patients in 2002 and 2009. Thirty-five percent of the patients reported substantial overall improvement at follow-up, but almost all still had pain of some degree after many years. The initial high level of emotional distress was unchanged. Low baseline pain intensity predicted improvement over time.

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  • 38.
    Pigg, Maria
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Baad-Hansen, Lene
    Drangsholt, Mark
    Svensson, Peter
    Malmö högskola, Faculty of Odontology (OD).
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Clinical findings in atypical odontalgia: reliability of dental examination2015In: Journal of Dental Research, Vol. 94, no Special Issue A, article id 0421Article in journal (Other academic)
  • 39.
    Pigg, Maria
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Baad-Hansen, Lene
    Elmasry Ivanovic, Susanne
    Faris, Hanan
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Svensson, Peter
    Malmö högskola, Faculty of Odontology (OD).
    Drangsholt, Mark
    Reliability of intraoral QST in patients with atypical odontalgia2013In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 92, no Special Issue A, article id 2671Article in journal (Other academic)
  • 40.
    Pigg, Maria
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Baad-Hansen, Lene
    Svensson, Peter
    Malmö högskola, Faculty of Odontology (OD).
    Drangsholt, Mark
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Reliability of intraoral quantitative sensory testing (QST)2009In: Swedish Dental Journal, ISSN 0347-9994, Vol. 33, no 4, p. 222-223Article in journal (Other academic)
    Abstract [en]

    Aim The prevalence of orofacial pain is reported to be around 20%. The most common location is intraoral, including recurrent and persistent pain conditions. Clinical signs and symptoms have been reported to overlap between nociceptive and neuropathic pain conditions, leading to difficulties in differential diagnosis. Somatosensory changes are important clinical features of neuropathic pain, and a comprehensive clinical examination including orofacial as well as qualitative and quantitative somatosensory examinations has been recommended for chronic intraoral pain investigations. The German Research Network on Neuropathic Pain (DFNS) has recommended a protocol with 13 quantitative sensory testing (QST) measures for detecting somatosensory abnormalities. Reliability is an important scientific property and has been adequately tested for cutaneous QST, but not for intraoral sites. The aim of this study was to evaluate the inter-examiner and intra-examiner (test-retest) reliabilities of the DFNS protocol at intra- and extraoral trigeminal sites. Material and methods Twenty-one healthy volunteers from Malmö University, Malmö, Sweden (13 women and 8 men, mean age 40.4 years, range 24–71) participated. Two independent examiners previously trained in the DFNS QST protocol examined the participants using the entire protocol. Each participant was examined twice on the same day, once by each examiner (inter-examiner reliability). After 1–3 weeks, one examiner re-examined all participants (intra-examiner reliability). The measurements were made on the skin of the right cheek, the tip of the tongue, and bilaterally on the gingival mucosa of the upper premolar region. The intraclass correlation coefficient (ICC) or kappa was used to calculate variations. Results Most tests had acceptable to excellent inter-examiner (ICC 0.41–0.89) and intra-examiner (ICC 0.43–0.87) reliability. For each test, inter- and intra-examiner reliabilities at intra- and extraoral sites were similar. No significant differences between right and left sides were found intraorally. Conclusion We conclude that inter- and intra-examiner reliabilities of most QST measures according to the DFNS protocol are acceptable for assessing somatosensory function in the orofacial region.

  • 41.
    Pigg, Maria
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Baad-Hansen, Lene
    Svensson, Peter
    Malmö högskola, Faculty of Odontology (OD).
    Drangsholt, Mark
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Reliability of intraoral quantitative sensory testing (QST)2010In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 148, no 2, p. 220-226Article in journal (Refereed)
    Abstract [en]

    The German Research Network on Neuropathic Pain (DFNS) has recommended a protocol with 13 quantitative sensory testing (QST) measures for detecting somatosensory abnormalities. Reliability is an important scientific property and has been adequately tested for cutaneous QST. This study evaluates intraoral sites for which no reliability trials have yet been published. Inter- and intra-examiner reliability of 13 QST measures at intra- and extraoral trigeminal sites were investigated. Twenty-one healthy volunteers from Malmö University, Malmö, Sweden (13 women and 8 men, mean age 40.4 years, range 24–71) participated. Two independent examiners previously trained in the DFNS QST protocol examined the participants using the entire protocol. Each participant was examined twice on the same day, once by each examiner (inter-examiner reliability). After 1–3 weeks, one examiner re-examined all participants (intra-examiner reliability). The measurements were made on the skin of the right cheek, the tip of the tongue, and bilaterally on the gingival mucosa of the upper premolar region. The intraclass correlation coefficient (ICC) or kappa was used to calculate variations. Most tests had acceptable to excellent inter-examiner (ICC 0.41–0.89) and intra-examiner (ICC 0.43–0.87) reliability. For each test, inter- and intra-examiner reliabilities at intra- and extraoral sites were similar. No significant differences between right and left sides were found intraorally. We conclude that inter- and intra-examiner reliabilities of most QST measures are acceptable for assessing somatosensory function in the orofacial region.

  • 42.
    Pigg, Maria
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Baad-Hansen, Lene
    Svensson, Peter
    Malmö högskola, Faculty of Odontology (OD).
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Reliability of intraoral quantitative sensory testing (QST).2008Conference paper (Other academic)
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    FULLTEXT01
  • 43.
    Pigg, Maria
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Baad-Hansen, Lene
    Aarhus universitet, Danmark; Scandinavian Center for Orofacial Neurosciences (SCON).
    Svensson, Peter
    Aarhus universitet, Danmark; Scandinavian Center for Orofacial Neurosciences (SCON).
    Skjelbred, Per
    Oslo universitetssykehus, Norge.
    Larheim, Tore A
    Universitetet i Oslo, Norge.
    Neuropatisk orofacial smärta: diagnostik och hantering2015In: Tandläkartidningen, ISSN 0039-6982, Vol. 107, no 3, p. 56-62Article, review/survey (Refereed)
    Abstract [en]

    In addition to patients with the more familiar and common orofacial pain conditions, the dentist will occasionally encounter patients with neuropathic pain. The article describes and explains the clinical presentation of neuropathic pain and gives an overview of painful conditions in the trigeminal region attributed to neuropathic causes with a varying degree of certainty. Aetiology, pain mechanisms, prevalence, diagnosis, evidence-based management and prognosis are reviewed, with the aim to enable the dentist to recognize and diagnose neuropathic pain, thereby facilitating correct management.

  • 44.
    Pigg, Maria
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Björnsson, Olof
    Kopp, Sigvard
    Alstergren, Per
    Malmö högskola, Faculty of Odontology (OD).
    Clinical diagnosis of temporomandibular joint arthritis2014In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 93, no Special Issue B, article id 110Article in journal (Other academic)
  • 45.
    Pigg, Maria
    et al.
    Malmö University, Faculty of Odontology (OD).
    Brodén, Joséphine
    Malmö University, Faculty of Odontology (OD).
    Fransson, Helena
    Malmö University, Faculty of Odontology (OD).
    Vareman, Niklas
    Department of Medical Ethics, Lund University, Sweden.
    How do we and how should we deal with uncertainty in Endodontics?2022In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 55, no 4, p. 282-289Article, review/survey (Refereed)
    Abstract [en]

    In many clinical cases a dentist may feel certain when for example diagnosing, deciding on treatment, or assessing the prognosis - in other cases many dentists may feel a degree of doubt or uncertainty. This paper aims to explore the philosophical concept of uncertainty and its different dimensions, using the condition "persistent apical periodontitis associated with a previously root filled tooth" as an example. Acknowledging that uncertainty exists in any clinical situation can be perceived as uncomfortable, as some might regard it as a weakness. While some types of uncertainty met in dental practice can be addressed and reduced, there are other types which are inevitable and must be accepted. To make sound decisions, it is pertinent that the dentist reflects on and values the consequences of uncertainty. In this paper, a conceptual model is presented by which the dentist can identify the type of uncertainty in a clinical case, making it possible to decide on a strategy on how to manage the uncertainty and its possible consequences, with the aim to support the dentist's care for their patients. The understanding that uncertainty exists and the ability to acknowledge and be comfortable with it when making decisions should be addressed throughout our professional career, and thus ought to be developed during undergraduate education. Some suggestions on how teachers could target this are given in the paper.

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    fulltext
  • 46.
    Pigg, Maria
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Drangsholt, Mark
    Svensson, Peter
    Malmö högskola, Faculty of Odontology (OD).
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    7-year follow-up of patients with persistent idiopathic dentoalveolar pain: preliminary results2010Conference paper (Other academic)
    Abstract [en]

    Background: Persistent idiopathic facial pain (intraoral dentoalveolar subset), earlier described as atypical odontalgia (AO), is a chronic continuous dentoalveolar pain (CCDAP) condition commonly suggested to involve neuropathic pain mechanisms. The longterm prognosis of neuropathic pain conditions is generally not favorable, but has been insufficiently studied in intraoral pain patients. Aim: The aim of this prospective study was to examine the long-term prognosis of CCDAP (AO). Methods: We have earlier described the characteristics of 46 consecutive patients diagnosed with AO (List et al. 2007). Follow-up data on 27 of these patients have so far been collected and are included in this report. In 2002 and 2009, the patients completed validated questionnaires and instruments including pain and disability characteristics (pain frequency, characteristic pain intensity (CPI), average pain intensity (0-10 numerical rating scale, NRS) and graded chronic pain severity (GCPS)); psychological status (SCL-90 according to the RDC/TMD: depression and non-specific physical symptoms scores); ongoing treatment and a global improvement rating. Baseline and follow-up data were compared using paired samples t-test at 5 % significance level. Results: 23 women and 4 men were included (mean age 64, range 38-80 years). Pain frequency: 67% reported continuous pain at baseline and 33% at follow-up (p = .03). Occasional pain was reported by 0% at baseline compared to 19% at follow-up (p = .02). CPI scores (mean ± SD) decreased from baseline (59 ± 18) to follow-up (40 ± 25; p = .001). Also, average pain intensity decreased from baseline (5.6 ± 2.0) to follow-up (3.6 ± 2.5; p=.001). A >30 % pain reduction was seen for 24 % of the patients, 1-30 % pain reduction for 40 %, unchanged pain for 24 %, and 12 % reported increased pain. GCPS: Fewer patients scored Grade III-IV at follow-up (7.4 %) than at baseline (29.6 %; p=0.031). Grade 0 was 0% at baseline and 11.1 % at follow-up (p = .083). SCL-90 scores reported by the AO patients for depression at follow-up was: 39% severe, 26% moderate and 42% normal, and for non-specific physical symptoms 62% severe, 11% moderate and 27% normal with no significant differences between baseline and follow-up (p > .5). Global improvement: 54% rated their overall pain status as improved, 42% as unchanged and 4% as worse. Ongoing treatment was use of occlusal splints (41%); analgesics, tranquilizers and sedatives (all 22%); antidepressants (15%); physiotherapy (11%); and gabapentin or pregabalin (both 7%). Conclusions: The preliminary data suggest that a majority of CCDAP (AO) patients improve over time and experience pain reduction of some degree. Psychological status does not change accordingly, and a number of patients report unchanged or even increased pain. The objective of future analysis of this material will be to identify positive and negative predictors for persistent pain.

  • 47.
    Pigg, Maria
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Drangsholt, Mark
    Svensson, Peter
    Malmö högskola, Faculty of Odontology (OD).
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    A 7-year follow-up of patients with atypical odontalgia (AO)2011Conference paper (Other academic)
    Abstract [en]

    Background and Aim: Atypical odontalgia (AO) is a severe chronic dentoalveolar pain condition with a prevalence of about 3% after endodontic treatment. The etiology is suggested to involve neuropathic pain mechanisms, possibly deafferentation of primary sensory neurons in dental pulp. Prior to correct diagnosis, patients with AO frequently undergo multiple and repeated endodontic treatments because of unresolved pain. The aim of this prospective study was to examine the long-term prognosis of AO. Methods: The study included 43 patients diagnosed with AO. Baseline (2002) and follow-up (2009) data were collected by means of validated questionnaires and instruments including pain frequency, characteristic pain intensity (CPI 0—100 score), average pain intensity (0—100 numerical rating scale), graded chronic pain severity (GCPS), psychological status (depression and non-specific physical symptoms scores of the SCL-90R according to the RDC/TMD) and a global improvement rating (PGIC). Baseline and follow-up data were compared using paired samples t-test at 5% significance level. Results: 37 patients (86%) responded; 31 women and 6 men (mean age 63, range 38—81 years). 62% reported continuous pain at baseline and 27% at follow-up (p=.001); 0% at baseline and 16% at follow-up had occasional pain (p=.012). CPI scores decreased from baseline 61±19 to follow-up 39±25 (p<.001). Average pain also decreased, from 5.7±2.0 to 3.5±2.4 (p<.001). 11% had GCPS scores indicating high disability at follow-up compared to 32% at baseline (p=.003). 14% at follow-up and 0% at baseline reported no disability (p=.023). SCL-90R depression scores and non-specific physical symptoms scores showed no significant differences between baseline and follow-up, but remained high. 54% of the patients rated their global status as improved, 41% as unchanged and 5% as worse at follow-up. Conclusion: We conclude that a majority of AO patients experience pain reduction of some degree over time. Psychological status does not change accordingly.

  • 48.
    Pigg, Maria
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Drangsholt, Mark
    Svensson, Peter
    Malmö högskola, Faculty of Odontology (OD).
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Do somatosensory abnormalities and responsiveness to local anesthesia in the pain region predict long-term outcome in patients with persistent dento-alveolar pain disorder (PDAP)?2012Conference paper (Other academic)
    Abstract [en]

    Aim of investigation: Persistent dento-alveolar pain disorder (PDAP) is the suggested new name of an enigmatic condition often described as atypical odontalgia, characterized by severe and continuous pain in the teeth and jaws and possibly associated with neuropathic pain mechanisms. In a recent 7-year prospective study, regression analysis found that neither unresponsiveness to peripheral lidocaine injection nor the presence of unspecified somatosensory abnormalities in the pain region could predict pain persistence in PDAP over time. The present study aimed to further explore the relationship between long-term outcome and (i) specified somatosensory abnormalities in the pain region and (ii) the responsiveness to peripheral lidocaine injection, both assessed at baseline. Methods: 43 patients diagnosed with PDAP were followed from 2002 (baseline) to 2009 (follow-up). The long-term outcome measure was overall improvement over time, measured by the 7-point Patient Global Impression of Change (PGIC) scale. The ratings ‘very much improved’ or ‘much improved’ were considered clinically relevant improvement. Quantitative sensory testing (QST) profiles included 9 measures assessing (i) thermal and mechanical function (normo-, hypo-, or hyperfunction), and (ii) signs of central sensitization (CS) (present/absent). Lidocaine injection in the pain area was double-blinded and placebo-controlled, and effective anesthesia was defined as ≥50% reduction in pain 30 min after administration. Descriptive statistics and logistic regressions analyzed the relationship between long-term outcome (PGIC), baseline patient somatosensory characteristics, and baseline lidocaine responsiveness. Results: Follow-up data were available for 37 patients, of which data on both QST profiles and responsiveness to lidocaine injection were available for 26 (70%). 8/26 patients (31%) experienced clinical improvement in their overall pain situation over time. 21/26 patients (81%) had at least one sensory abnormality. Stratified into subgroups, 9 patients (35%) had signs of CS only (represented by gain in windup ratio and/or dynamic mechanical allodynia to brush or vibration stimulus); 6 (23%) had CS + hypofunction in mechanical or thermal perception; 4 (15%) had CS + hyperfunction in mechanical and/or thermal perception and 2 (8%) displayed only hypofunction in mechanical and/or thermal perception. None of the subgroups were associated with overall improvement over 7 years (OR 0.250–0.875, P=0.317–0.923). Average pain before lidocaine injection was 41 mm VAS (SD 25). 30 minutes after injection, 12/26 patients (46%) experienced a ≥50% pain reduction. Effective pain relief from lidocaine was not associated with overall improvement over time (OR 1.25, P=0.793). When QST profiles and lidocaine responsiveness were combined, no possible combination could predict overall improvement (P=0.998–1.0). Conclusion: No predictive value for the long-term outcome of patients with PDAP was found for (i) somatosensory abnormalities revealed by QST, (ii) the responsiveness to peripheral lidocaine injection in the painful region, or (iii) the combination of these. The results should be interpreted with caution due to study design and relatively small sample size, but suggest that these parameters are not strongly associated with long-term outcome as measured by the PGIC instrument.

  • 49.
    Pigg, Maria
    et al.
    Malmö University, Faculty of Odontology (OD).
    Duncan, Henry F.
    Trinity Coll Dublin, Dublin Dent Univ Hosp, Div Restorat Dent, Dublin, Ireland..
    Nagendrababu, Venkateshbabu
    Univ Sharjah, Dept Prevent & Restorat Dent, Coll Dent Med, Sharjah, U Arab Emirates..
    Abbott, Paul
    Univ Western Australia, UWA Dent Sch, Nedlands, WA, Australia..
    Fouad, Ashraf F.
    Univ Alabama Birmingham, Sch Dent, Birmingham, AL 35294 USA..
    Kruse, Casper
    Aarhus Univ, Sect Oral Radiol, Dept Dent & Oral Hlth, Aarhus, Denmark..
    Patel, Shanon
    Kings Coll London, Fac Dent Oral & Craniofacial Sci, London, England..
    Rechenberg, Dan-Krister
    Univ Zurich, Dept Conservat & Prevent Dent, Zurich, Switzerland..
    Dummer, Paul M. H.
    Cardiff Univ, Sch Dent, Coll Biomed & Life Sci, Cardiff, Wales..
    Preferred Reporting Items for Diagnostic Accuracy Studies in Endodontics (PRIDASE): Guidance to improve manuscripts assessing the diagnostic accuracy of procedures, techniques and devices2021In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 54, no 7, p. 1005-1007Article in journal (Other academic)
  • 50.
    Pigg, Maria
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Elmasry Ivanovic, Susanne
    Baad-Hansen, Lene
    Svensson, Peter
    Malmö högskola, Faculty of Odontology (OD).
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Drangsholt, Mark
    Reliability of intraoral chair-side somatosensory examination - preliminary report2010In: Journal of Dental Research, Vol. 89, no Special Issue B, article id 1204Article in journal (Other academic)
    Abstract [en]

    http://iadr.confex.com/iadr/2010barce/webprogramschedule/Paper134347.html

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