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ORIGINAL ARTICLE
Year : 2006  |  Volume : 24  |  Issue : 3  |  Page : 140-143
 

Determining toothache severity in pediatric patients: A study


Department of Oral and Maxillofacial Pathology, Saveetha Dental College, Chennai, India

Correspondence Address:
V Gupta
Dept. of Oral and Maxillofacial Pathology, Saveetha Dental College, 162, P. H. Road, Vellapanchavadi, Chennai - 77
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.27894

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   Abstract 

To correlate sodium-potassium levels in saliva of pediatric patients having different intensities of toothache assessed by Visual Analogue Scale (VAS) in age group 3-14 yrs. A prospective study of 50 children having different intensities of pain was carried out in the Dept. of Pedodontics, Sareetha Dental College and Hospital. 50 children (aged 3-14 yrs) having different intensities of toothache including normal children (control) were included in the study. Saliva samples were collected and Na+, K+ levels in saliva were measured by using Na+, k+ colorimeter kit. Photographs were taken using Digital camera and VAS was prepared accordingly. Sodium levels decreased with increasing pain intensity and potassium levels increased, facial expressions correlated with Na+, K+ levels. Correlation between Na+, K+ levels and pain intensity exists. Also, VAS is a valid measure for pain.


Keywords: Colorimeter, pain assessment, pain intensity, visual analogue scale


How to cite this article:
Gupta V, Chandrasekar T, Ramani P, Anuja. Determining toothache severity in pediatric patients: A study. J Indian Soc Pedod Prev Dent 2006;24:140-3

How to cite this URL:
Gupta V, Chandrasekar T, Ramani P, Anuja. Determining toothache severity in pediatric patients: A study. J Indian Soc Pedod Prev Dent [serial online] 2006 [cited 2019 Sep 22];24:140-3. Available from: http://www.jisppd.com/text.asp?2006/24/3/140/27894



   Introduction Top


Pain is a complex multidimensional concept that can vary in quality, intensity, duration and location.[1] Children may therefore, experience different levels of pain from the same stimulus.[1] Children as young as 2-3 yrs can report pain, although at this age, they are not able to rate the intensity.[2] Children at any age may deny pain if, the questioner is a stranger, if they believe they are supposed to be brave, if they are fearful or if they anticipate receiving an injection for pain.[2],[3],[4] Therefore finding a gold standard for the objective assessment of pain in young children indeed is a challenging and critical task for health professionals. So to choose an ideal measure for assessment of pain; we should see its validity, ease to administer and score in a clinical context and its appropriateness for use with children.[5] In order to cover all these criteria, the most obvious choice would be to employ a scale based on facial expressions indicating different intensities of pain. VAS is such a scale comprising of faces showing facial expressions ranging from no pain to severe pain and therefore applicable in measuring severity of toothaches.[6] Besides, this measure is of practical use to the dental practitioner. Techniques such as projective tests and behavioral observation are not designed for everyday use by the clinician.[5] They require experience in using and interpreting results. In addition, they are also time consuming. The non - invasive nature of salivary sampling for determining endogenous Na+, K+ levels has been seen to be an advantageous technique in determining pain intensity as Na+, K+ ions are related to impulse transmission through nerve fibre. So the aim of the study is to correlate Na+, k+ levels in saliva of pediatric patients having different intensities of toothache assessed by VAS in age group (3-14 yrs.)


   Materials and Methods Top


Sample

50 children (3-14 yrs of age) who reported to Dept of Pedodontics, Saveetha Dental College and Hospital, were including in the study.

Scale



Visual Analogue Scale (VAS) (Diag.1) comprises a row of five faces showing expressions ranging from no pain to severe pain.[5] The scale is scored by giving a value of one to the face which was not showing any expressions for pain and value of five to the severely pain affected face.[5]

Out of 50 children, 10 VAS were prepared, each VAS containing 5 children having expressions of no pain to severe pain as shown in Diag. 1.

The Na+, k+ levels in saliva were measured for all by using Na+, k+ colorimeter kit and collecting saliva samples. In addition photographs of the patients were taken by using Digital camera (Nikon, 5.1 Mpixel, Japan). VAS were prepared and Na+, k+ values in saliva were correlated with facial expressions.

Estimation of Na+, k+ levels in saliva

Saliva samples were collected from patients having different intensities of pain taking normal children as control. Saliva samples were collected in clean sterilized container by allowing the patients to spit in clean and sterilized glass funnel.Thereafter, without any delay colorimetric estimation of Na+, K+ levels was done by using ECA - 3, ELYTE, CRESTO, colorimeter kit (Dr. Reddy's Laboratories, Hyderabad, AP, India) by following procedure:

Sodium assay

Step 1: System parameters were standardized [Table - 1].

Step 1: Precipitation of sodium. (pipetting scheme), [Table - 2].

Step 2: Color development. (pipetting scheme) [Table - 3].

Potassium assay

Step 1: System parameters were standardized [Table - 4].

Step 2: Precipitation of potassium (Pipetting scheme) [Table - 5]

Calculations:

a) Sodium in mmol / l = B-T/ B-S X 150

b) Potassium in mmol / l = A of (T) / A of (S) X 5.

(A: Absorbance; B: Blank; S: Standard; T: Test) [Table - 6]


   Results Top


A study sample of 50 children participated in the study.Among them 60 % were boys, 40% were girls The age limit of the patients was between 3-14 yrs. Mean age was 10 yrs. No significant difference was found between boys and girls. Therefore, results were not affected by difference in sex although literature indicates that girls experience more intense painful stimuli than boys.[7] The presence of severe pain was accompanied by a high incidence of children who cried and were awakened by pain. Sodium levels decreased and potassium levels increased with increasing pain intensity and facial expressions correlated with Na+, K+ levels as shown in photographs [Figure - 1][Figure - 2][Figure - 3][Figure - 4][Figure - 5], [Table - 7], [Graph 1]. Sodium levels varied from 165-173.2 mmol/l with mean value 170.6 and potassium levels varied from 12-16.2 with mean value 14.1. Here, to find correlation between pain score and Na+, K+ levels Kendall's Rank correlation coefficient was used, which is a nonparametric method of correlation. This method is used to assess relation between two ordinals or one ordinal and one continuous variable.

In this study, we have pain score as an ordinal variable and Na+, K+ values as continuous variables. Correlation between pain score and Na+ levels was found to be 90% negative i.e., if pain increases, Na+ levels decreases and vice versa.

Around 89% positive correlation was found between pain score and K+ levels i.e., if pain increases, K+ levels also increases and vice versa. No correlation was found between age and sex with Na+ and K+ values.


   Discussion Top


The Na + levels decreased and K+ levels increased with increasing pain intensity. Positive correlation was seen between pain score and K+ values and negative correlation seen between pain score and Na+ values.No correlation was found between age and sex with sodium and potassium values.While impulse transmission along nerve facilitates three Na+ ions to move into neuron from extracellular fluid and two K+ ions move out of neuron into the extracellular fluid.[8],[9] Also with increasing pain, salivary flow decreases due to which Na+ decreases and K+ increases.[10] The average normal values for Na+ and K+ in saliva were found to be 173.4 and 12.4 mmol/l respectively in our study which is within serum values and K+values were found greater than those of serum.[10] Moreover the facial expressions also correlated with Na+, K+ levels during the study. So VAS is a valid measure for pain.[11],[12],[13] VAS scales commonly used to obtain self reports of pain intensity from children[14] and it is a valid tool that can be used in both clinical trials and everyday clinical practice[15] as attenuated by the Na+, K+ levels. The findings of this study indicate that VAS is a valid measure for pain as facial expressions correlated with Na+, K+ levels. Also, correlation between Na+, K+ levels and pain intensity exists. Clinical significance of this study is that practitioners can use VAS when patient arrives for treatment and inform the dental team of pain the child may be suffering and accordingly manage the child's behaviour.


   Acknowledgement Top


The authors wish to thank Dr. Rathnaprabhu, Prof. and Head of Pedodontics Dept. SDCH, Chennai, for his immense contribution and support.

 
   References Top

1.Versloot J, Veercamp JS, Hoogstraten J. Assessment of pain by child, dentist and independent observers. Pediatr Dent 2004;26:445-9.  Back to cited text no. 1    
2.Pain, clinical updates, International association for the study of pain. 1995.   Back to cited text no. 2    
3.Ambuel B, Hamlett KW, Marx CM, Blumer JL. Assessing distress in pediatric intensive care environments: The COMFORT scale. J Pediatr Psychol 1992;17:95-109.  Back to cited text no. 3  [PUBMED]  
4.Krechel SW, Bildner J. CRIES: A new neonatal postoperative pain measurement score. Initial testing of validity and reliability. Pediatr Anaesth 1995;5:53-61.  Back to cited text no. 4  [PUBMED]  
5.Buchanen H, Niven N. Validation of facial image scale to assess child anxiety. Int J Pediatr Dent 2002;12:47-52.   Back to cited text no. 5    
6.Barreto Ede P, Ferreira e Ferreira E, Pordens IA. Evaluation of toothache severity in children using a visual analogue scale of faces. J Pediatr Dent 2004;26:485-91.   Back to cited text no. 6    
7.Frot M, Feine JS, Bushnell MC. Sex differences in pain perception and anxiety. A psychological study. Pain 2004;108:230-6.   Back to cited text no. 7  [PUBMED]  [FULLTEXT]
8.Nerve physiology. Guyton AC, Hall JE. Medical Physiology, 10th ed, Harcourt Asia Pvt Ltd. W.B Saunder's Company: p. 59-61   Back to cited text no. 8    
9.Nerve physiology: Ganong WF. Medical Physiology, 21st ed. Lange Publication: McGraw Hill Company; p. 60-1.   Back to cited text no. 9    
10.Salivary glands. Hand AR. Orban's; Oral histology and embryology; 11th ed. Harcourt and Brace Company Asia Pvt Ltd: Singapore.  Back to cited text no. 10    
11.Hain RD. Pain scales in children: A review. Palliat Med 1997;11:341-50.   Back to cited text no. 11  [PUBMED]  
12.Wong DL, Baker CM. Pain in children: Comparison of assessment scales. Pediatr Nurs 1988;14:9-17.   Back to cited text no. 12  [PUBMED]  
13.Hicks CL, von Baeyer CL, Spafford PA, van Korlaar I, Goodenough B. The Faces Pain Scale-Revised: Towards a common metric in pediatric pain measurement. Pain 2001;93:173-83.   Back to cited text no. 13  [PUBMED]  [FULLTEXT]
14.Chambers CT, Herdial J, Craig KD, Court C, Montgomery C. Faces scales for the measurement of postoperative pain intensity in children following minor surgery. Clin J Pain 2005;21:277-85.  Back to cited text no. 14    
15.Belville RG, Seupaul RA. Pain assessment in pediatric emergency care: A review of the faces pain scale-revised. Pediatr Emerg Care 2005;21:90-3.   Back to cited text no. 15  [PUBMED]  [FULLTEXT]


    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6], [Figure - 7]

    Tables

[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6], [Table - 7]



 

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    Abstract
    Introduction
    Materials and Me...
    Results
    Discussion
    Acknowledgement
    References
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