Prevalence of and factors affecting post-obturation pain in patients undergoing root canal treatment

AIM: This longitudinal, prospective study (1) investigated the prevalence of post-obturation pain after root canal treatment and (2) evaluated the influence of factors affecting the pain experience. METHODOLOGY: Twenty practitioners, comprising general dental practitioners, MSc graduates and Endodontists, participated in this study. The patient sample (n = 415) was derived from consecutive patients attending the practitioners' surgeries for root canal treatment on a single tooth. Demographic, medical history, preoperative and intra-operative data as well as pain experience on day 1 and day 2 after root canal obturation were recorded. Intensity of pain experienced was recorded on a visual analogue scale (VAS) of 0-5. The data were analysed using logistic regression models. RESULTS: The prevalence of post-obturation pain within 48 h after treatment was 40.2% (n = 167) but less than 12% of patients experienced severe pain (VAS 4 or 5) on either day 1 or day 2. The factors that significantly influenced post-obturation pain experience were: gender (OR = 0.434, P < 0.001), tooth type (OR = 1.733, P = 0.007), size of periapical lesion (OR = 0.493, P = 0.004), history of post-preparation pain (OR = 4.110, P = <0.001) or generalized swelling (OR = 3.435, P = 0.005) and number of treatment visits (OR = 2.604, P < 0.001). CONCLUSIONS: The prevalence of post-obturation pain was high (40.2%). The important prognostic determinants of post-obturation pain were female, molar tooth, size of periapical lesion smaller than 3 mm, history of post-preparation pain or generalized swelling and single-visit treatment.     

Incidence and Related Factors Associated with Postpreparation Pain after Intracanal Procedures in a Dental Teaching Hospital

目的:了解根管预备后疼痛发生率,并对一些可能与疼痛发生有关的因素进行分析.方法:选取2001年7月至2002年2月间武汉大学口腔医院牙体牙髓科完成的非一次法根管治疗纪录表,将相关信息输入计算机后作Chi-square test和logistic回归分析.结果:根管预备后疼痛发生率为11.5%.单因素分析和logistic回归发现身体状况、年龄、牙位于上颌或下颌、术前有无叩痛及牙髓活力为影响疼痛发生率的主要因素.结论:根管预备术后疼痛发生率较低;根管预备术后疼痛发生率受多种因素影响.     

Prevalence of persistent pain after endodontic treatment and factors affecting its occurrence in cases with complete radiographic healing

AIMS: To (i) determine the prevalence of persistent dento-alveolar pain following nonsurgical and/or surgical endodontic treatment conducted in a teaching dental hospital and (ii) identify the risk factors associated with persistent pain after apparently successful root canal treatment. STUDY DESIGN: A total of 175 patients/teeth were reviewed 12-59 months following treatment. The patients were examined clinically and radiographically and a detailed pain history obtained. Multiple logistic regression analysis was used to investigate the association between potential risk factors and persistent pain after successful endodontic treatment. RESULTS: The prevalence of persistent pain after successful root canal treatment was 12% (21/175). Treatment success was determined by the absence of clinical and radiographic signs of dental disease. The factors that were significantly (P < 0.05) associated with persistent pain following endodontic treatment were: 'duration of preoperative pain' [odds ratio (OR) = 8.6], 'preoperative pain from the tooth' (OR = 7.8), 'preoperative tenderness to percussion' (OR = 7.8), 'previous chronic pain problems' (OR = 4.5), 'gender' (OR = 4.5) and 'history of painful treatment in the orofacial region' (OR = 3.8). 'Type of treatment received (surgical or nonsurgical treatment)' showed borderline significance at the 10% level. CONCLUSIONS: The presence and duration of preoperative pain from the tooth site, lasting at least 3 months, a positive history of previous chronic pain experience or painful treatment in the orofacial region, and female gender were important risk factors associated with persistent pain after successful endodontic treatment.     

Pain associated with root canal treatment

Aim  To determine the pain experienced by patients during root canal treatment and to correlate with age and gender, pulpal diagnosis, previous periapical status, dental characteristics and length of treatment.
Methodology  One hundred and seventy-six patients (68 men and 108 women), with ages ranged from 6 to 83 years, were randomly recruited. Patients completed a 10-cm visual analogue scale (VAS) that ranked the level of pain experienced during root canal treatment.
Results  The mean pain level during root canal treatment was 1.2 ± 0.8 in a VAS between 0 and 10. Fifty-four per cent of patients did not experience pain. There were no significant differences in relation to gender or age groups. Mandibular teeth had a significantly ( P  < 0.05) higher percentage incidence of pain in comparison with maxillary teeth. Pain was absent in 63% of anterior teeth compared with 44% in posterior ones ( P  < 0.01). Interventions shorter than 45 min resulted in a significantly higher percentage of pain absence ( P  < 0.05). Root canal treatment was significantly ( P  < 0.05) more painful in teeth with irreversible pulpitis and acute apical periodontitis compared to the group with necrotic pulps and chronic apical periodontitis ( P  = 0.049).
Conclusions  Root canal treatment in teeth with irreversible pulpitis and acute apical periodontitis was more painful. Age, tooth type and length of the treatment were factors associated with increased risk for pain experienced during the procedure. Knowledge of pain levels endured by patients will allow dentists to decide when to use supplemental local anaesthesia.     

Postoperative pain and associated factors in adolescent patients undergoing two‐visit root canal therapy

This prospective study investigated the frequency and intensity of postoperative pain and identified associated factors in adolescents undergoing two‐visit root canal therapy. Sixty‐four patients aged 11 to 18 years old presenting with molars with pulp necrosis were assigned consecutively to two visits (plus an interappointment dressing using calcium‐hydroxide paste). Pain intensity was recorded on a visual analogue scale (VAS) of 0–5. Data were analysed using multivariate logistic regression. The frequency of postoperative pain was 32.8% (21/64), with intensities of VAS 1 and VAS 2 in 81%, VAS 3 in 14.3% and VAS 4 in 4.7% of the 21 cases in which it was experienced. Spontaneous preoperative pain (odds ratio (OR) = 6.60; 95% confidence interval (CI) = 1.61–26.97; P = 0.009) and absence of apical perodontitis (OR = 5.65; 95% CI = 1.34–23.87; P = 0.01) were associated with postoperative pain. The frequency of postoperative pain was high, but the intensity, in general, was low, including flare‐ups. The presence of spontaneous preoperative pain and absence of apical periodontitis increase the probability of suffering from postoperative pain.     

Influence of Preoperative Mechanical Allodynia on Predicting Postoperative Pain after Root Canal Treatment: A Prospective Clinical Study

IntroductionOdontogenic pain can manifest as pulpal pain, periapical pain (mechanical allodynia), or both. This study aimed to assess the changes in the intensity of mechanical allodynia (MA) and to identify predictors of postoperative pain after root canal treatment (RCT).MethodsIn total, 579 consecutive patients who required RCT were enrolled; we included patients with asymptomatic pulpal diagnoses to avoid any effects of preoperative spontaneous pain on postoperative pain and to evaluate MA independently. Using a visual analog scale (VAS), patients separately indicated the intensity of spontaneous pain, tenderness to percussion, and pain on biting; these measurements were performed before treatment (preoperative pain), at the beginning of each visit (postpreparation pain), and daily for 1 week after RCT (postobturation pain). For analytical purposes, patients were subdivided into 2 groups based on the intensity of preoperative MA (none to mild [VAS <4] or moderate to severe [VAS ≥4]) to evaluate changes in MA and predictive factors of moderate to severe postoperative pain. A generalized estimating equation, repeated-measures analysis of variance, and logistic regression analysis were used.ResultsAlthough the intensity of MA was significantly higher in the moderate to severe group after the initiation of RCT (P < .05), 93% of them experienced alleviation in MA, and 30% of patients in the none to mild group experienced an increase in MA. After adjusting for clinical variables, moderate to severe preoperative MA and the presence of necrotic pulp were significantly correlated with moderate to severe postoperative pain with an odds ratio of 4.107 and 0.286, respectively.ConclusionsModerate to severe preoperative MA was a predictive factor of postoperative pain in patients undergoing RCT.     

视觉模拟评分法评估根管治疗术后疼痛程度及疼痛相关因素分析

目的探讨临床上根管治疗术后发生疼痛的相关因素，包括年龄、性别、术前诊断、牙位、充填情况、是否超充、是否存在术前疼痛等。 方法按受试者入选的先后顺序随机选取2018年7月至2019年4月在汕头大学医学院口腔门诊部行上、下颌磨牙及前磨牙根管治疗的患者140例，其中男63例、女77例，记录其首诊情况。统一采用开髓车针获得入口，根管预备方式统一采用标准技术，完成预备后导入氢氧化钙糊剂消毒根管，并采用玻璃离子暂时封闭开髓口。1周后患者复诊，去除暂封物后采用热牙胶垂直加压充填技术完成根管充填，并拍摄术后根尖X线片。24 h后患者复诊，采用视觉模拟评分（VAS）法对术后疼痛进行评估，记录数据并进行单因素相关性分析和多因素Logistic回归综合分析。 结果共纳入病例140例，84例（60%）出现根充后不适。其中61例（43.6%）患者报告轻度疼痛，中度疼痛和重度疼痛的患者分别为9例（6.4%）和14例（10%）。无患者出现极重度疼痛。卡方检验显示，术后出现疼痛与性别及牙齿类型无关，但是与诊断即术前牙髓感染状态（χ² = 76.11，P<0.001）及根充效果（χ² = 16.3，P<0.001）有关。多因素Logistic回归分析显示术前没有症状，术后疼痛也会相应减少（OR = 0.179，P = 0.048）；糊剂没有超出，也会降低疼痛的发生程度（OR = 0.039，P = 0.005）；慢性牙髓炎发生术后疼痛症状相对于根尖周炎会轻（OR = 0.034，P<0.001），而牙髓坏死相对于根尖周炎会增加术后疼痛表现（OR = 4.08，P = 0.038）。与超充相比，恰填（OR<0.001，P<0.001）与欠填距离根尖<2 mm（OR<0.001，P<0.001）都会减轻术后疼痛表现。 结论临床医生在操作中应尽量避免超充，在根管预备过程对根尖区的保护，以及糊剂量的控制对避免根充后疼痛尤为重要。对于牙髓坏死和根尖周炎的患者应做好术后沟通工作。     

Risk analysis of failure of root canal treatment for teeth with inaccessible apical constriction

OBJECTIVE: The risk of failure of root canal therapy was assessed in teeth with inaccessible apical constriction and factors influencing treatment outcome in these teeth were analyzed. METHODS: From the same 57 patients, one tooth with inaccessible apical constriction (n=57) and one tooth with adequate accessibility (n=57) were included in this retrospective investigation. Cox regression analysis was used to analyze factors that may have influenced the outcome one or more years after obturation. These factors included inaccessibility, systemic disease, canal curvature, preoperative periradicular lesion, widening of periodontal ligament space, patient gender and age, size of master apical file, preoperative pulp vitality, years of operator experience and obturation length. RESULTS: Inaccessible apical constriction was a significant factor related to outcome (odds ratio, 5.301). Preoperative presence of periradicular lesion significantly influenced the outcome in cases with inaccessibility (odds ratio, 4.448). CONCLUSION: Inaccessibility increases the risk of root canal therapy failure particularly in teeth with preoperative periradicular lesion.     

2种根管预备终止点对术后疼痛的影响

目的 评价根管预备中2 种不同根管预备终止点对术后疼痛的影响. 方法 需做根管治疗的患者118例用Endo Pilot根测仪进行根尖定位,随机分成2组:A组(59例),根管预备终止点位于根测仪指示"弧形基线"上最高点(蜂鸣声35次/min);B组(59例),根管预备终止点位于根测仪指示"弧形基线"下最低点(蜂鸣声65次/min). 用疼痛视觉模拟评分法( visual analogue scale,VAS)的分值,记录2组患者根管预备前和术后12 h、1 d、2 d、3 d、1周疼痛情况. 结果 118颗患牙疼痛的总发生率为18. 6%,其中A组为16. 9%(10/59),B组为20. 3%(12/59),2组疼痛发生情况差异无统计学意义(P>0. 05);A、B 2组在各时间段VAS疼痛分值差异无统计学意义(P>0. 05). 结论 根管预备中2种根管预备终止点对术后疼痛无明显影响.     

一次根管治疗术与两次根管治疗术术后短期临床疗效的比较

目的比较一次根管治疗术与两次根管治疗术术后短期临床疗效,并分析不同因素对疗效的影响。方法将96例需行根管治疗的患者随机分成2组,分别进行一次根管治疗术（一次治疗组）和两次根管治疗术（两次治疗组）,并在术后的1、3d和1周进行随访,记录其疼痛情况,术后3个月行影像学检查,评估分析其短期疗效。结果一次治疗组和两次治疗组在术后短期疼痛和影像学检查方面的差异均无统计学意义;患者的性别及患牙术前根尖周指数（PAI）对根管治疗的术后疗效有一定影响,而患者年龄、患牙解剖牙位、患牙牙髓情况（未出现根尖周病损）的差异对根管治疗术术后疗效影响意义不大。结论一次性根管治疗在术后短期的疼痛发生率较低,在临床可根据实际情况推广应用;患者性别及术前PAI会影响根管治疗的术后疗效。     

Root canal treatment in Denmark is most often carried out in carious vital molar teeth and retreatments are rare

AIM: To study the reasons given by a representative sample of Danish general dental practitioners (GDPs) for undertaking root canal treatment and, to investigate their confidence in performing root canal treatment on molar teeth. METHODOLOGY: A questionnaire was sent to 600 Danish GDPs randomly selected from the roster of the Danish Dental Association. They were asked to recall various factors about their experience of the last root filling they completed, including the reason for treatment and the pulp diagnosis. Self-assessments on 100-mm visual analogue scales (VAS) were reported concerning the confidence in performing root canal treatment of a molar. End-point definitions were 'very easy' (0) and 'very difficult' (100), respectively. Time reports of molar treatments were given in categorized groups. RESULTS: The most frequent reason for performing root canal treatment was caries within the tooth involved (55%). The majority of treatments involved teeth with vital pulps (54%). Retreatments were carried out in 2% of the cases. The confidence in performing root canal treatment varied but was relatively high, expressed as VAS-values below 50. The creation of an aseptic working field was regarded as the most difficult procedure followed by root canal preparation. Fifty-six percent of the responders stated a time frame of 46-75 min to complete root filling in a molar tooth. CONCLUSIONS: Root canal treatment in Denmark was reported to be undertaken most often because of caries. Treatment was typically performed in molar teeth with vital pulp. Even though apical periodontitis was frequently noted in root filled teeth, retreatments were rare. From a subjective perspective root canal treatment was not considered to be very difficult and was carried out relatively rapidly.     

Patients' perceptions regarding microimplant as anchorage in orthodontics

OBJECTIVE: To determine patients' expectations, acceptance, and experience of pain with microimplant surgery compared to other orthodontic procedures. MATERIALS AND METHODS: Seventy-eight microimplants were placed in 37 patients as an anchorage unit for orthodontic treatment. Patients were asked to rate anticipated pain and pain experienced with various orthodontic procedures (tooth extraction, insertion of separators, initial tooth alignment, and microimplant surgery) on a visual analog scale (VAS) over a 7-day period. One month after insertion of microimplants, patients were asked to rate their acceptance of the procedure using a structured questionnaire. RESULTS: Unlike other orthodontic procedures, patients expected to experience a significantly higher level of pain with microimplant surgery than they experienced (P < .001). The postoperative pain experienced decreased continuously from day 1 to day 7 for all orthodontic procedures (P < .05). The total area under the curve (AUC) of pain experienced over the 7-day period was significantly larger for initial tooth alignment than for microimplant surgery (P < .05). Most patients were satisfied with the microimplant surgery (76%) and would recommend it to a friend or family member (78%). CONCLUSIONS: Patients tended to overestimate the pain anticipated with microimplant surgery. Patients were accepting of the surgery and would recommend it to others.     

The probability of and factors influencing tooth survival following non‐surgical root canal treatment – a prospective study

Aim To investigate the probability of and factors influencing tooth survival following primary or secondary root canal treatment. Methodology This prospective study involved annual follow‐up of up to 4 years of primary (759 teeth, 572 patients) or secondary (858 teeth, 642 patients) root canal treatment in an Eastman cohort. Informed consent was obtained from the patients. Pre‐, intra‐ and post‐operative data were collected prospectively on customised proforma. Information about extraction of the root treated tooth was reported by the patient, the referring dentist or extracted from the patient's hospital medical records. The timing and reasons for extraction were recorded. Tooth survival was estimated and prognostic factors investigated using Cox regression. Clustering effects within patients were adjusted in all models using robust standard error. Results The 4‐year tooth survival after primary root canal treatment (95.4%) or secondary root canal treatment (95.3%) were similar. Fourteen prognostic factors were identified. Significant patient factors included: History of diabetes and systemic steroid therapy. Significant pre‐operative factors included: narrow periodontal probing depth; pain; discharging sinus; cervical root resorption; and iatrogenic perforation (for retreatment cases only). Significant intra‐operative factors included: iatrogenic perforation; patency at apical terminus; and extrusion of root fillings. Significant post‐operative restorative factors included: Presence of cast restoration or temporary restoration; presence of cast post & core; proximal contacts with both mesial and distal adjacent teeth; and terminal location of the tooth. The presence of pre‐operative pain had a profound effect on tooth loss within the first 22 months after treatment (HR = 3.1; P = 0.001) with a lesser effect beyond 22 months (HR = 2.4; P = 0.01). Patency at the apical terminus reduced tooth loss (HR = 0.3; P < 0.01) within the first 22 months after treatment but had no significant effect on tooth survival beyond 22 months. Extrusion of gutta‐percha root filling did not have any effect on tooth survival (HR = 1.1; P = 0.2) within the first 22 months but significantly increased the hazard of tooth loss beyond 22 months (HR = 3.0; P = 0.003). Conclusions The 4‐year tooth survival following primary or secondary root canal treatment was 95%; with fourteen prognostic factors common to both.     

The relationship of intracanal medicaments to postoperative pain in endodontics

AIM: To investigate the relationship of postoperative pain to three different medicaments placed in the root canal after a complete biomechanical debridement of the root canal system in patients presenting for emergency relief of pain. METHODOLOGY: Two hundred and twenty-three teeth belonging to 221 patients presenting as emergencies to the Royal Dental Hospital of Melbourne were included in the study. Inclusion was limited to patients with a diagnosis of pulp necrosis and acute apical periodontitis. All teeth underwent conventional root canal treatment, which involved the instrumentation to the apices of each canal at the first visit. Canals were instrumented using a stepback technique and hand-files along with irrigants using Milton's (1% sodium hypochlorite) solution followed by 15% EDTAC. The canals were dried and one of the following three medicaments was inserted into the canal in random sequence: Group 1: Ledermix paste (Lederle Pharmaceuticals, Division of Cyanamid, Wolfratshausen, Germany); Group 2: calcium hydroxide paste (Calcipulpe, Septodont, France); and Group 3: no dressing. Before dismissal, the preoperative pain experienced on the previous night was recorded using a visual analogue pain scale. Patients were then instructed to record the degree of pain experienced 4 h after treatment and daily for a further 4 days. RESULTS: The mean score pain for all three groups was between 42 and 48 prior to treatment being commenced. After 4 days, the pain score for Group 2 was 10, for Group 3 was 7 and for Group 1 was 4. Mean preoperative pain level was 44.4 (of a maximum 100) for all groups, and declined by 50% (to 22.1) after 24 h. Patients in Group 1 (Ledermix) experienced significantly less (P = 0.04) postoperative pain than those in the other two groups. There was no significant difference between Group 2 (calcium hydroxide) and Group 3 (no dressing). CONCLUSION: Under the conditions of this study, painful teeth with acute apical periodontitis that had been dressed with Ledermix paste gave rise to less pain than that experienced by patients who had a dressing of calcium hydroxide or no dressing at all. Ledermix is an effective intracanal medicament for the control of postoperative pain associated with acute apical periodontitis, with a rapid onset of pain reduction.     

Incidence and factors associated with endodontic inter-appointment emergency in a dental teaching hospital in China

OBJECTIVE: To assess the incidence of endodontic inter-appointment emergency (EIE) in a dental teaching hospital in China, and to correlate its occurrence with preoperative and treatment parameters. METHODS: Three thousand six hundred and ninety six cases were collected at root canal treatment appointments on demographics, presenting symptoms, treatment procedures and periradicular status. The operators consisted of faculty, undergraduate students and advanced trainees. Root canals were conventionally instrumented and then medicated. No systemic medication was prescribed. In cases EIE developed between appointments, an emergency visit was arranged and active treatment was carried out. The data of EIE cases were statistically analyzed using the chi-square test and a multiple logistic regression model. RESULTS: The overall incidence of EIE was 5%, which rate was 5.5% in females and 4.3% in males. Analyses of the potential factors revealed that patient age, tooth location, preoperative percussion pain and pulp status were the most important independent variables. CONCLUSION: EIE was significantly associated with some host factors (patient age, tooth location) and presenting factors (preoperative percussion pain, pulp status).     

Ability of examiners to estimate the pain experienced by patients from probing during initial periodontal examination

BACKGROUND: The aims of the present study were to identify the level of pain experienced by patients from probing during periodontal examination, and to determine to what extent the examining periodontist and the dental assistant could estimate the degree of pain experienced by the patients. METHODS: For each of three periodontists, 20 patients referred for periodontal diagnosis and treatment were selected. The periodontist carried out his examination, which included probing at six sites per tooth. Following probing, the patients rated the pain using a visual analog scale (VAS). The periodontist and the dental assistant who helped out during the examination independently rated the pain level they perceived that each patient experienced, also using a VAS. RESULTS: Most patients showed low pain responses to probing. However, using an arbitrary threshold of VAS > or =40 mm to indicate significant pain, some patients had a painful experience. Differences were observed between the pain levels expressed by the three groups of patients. While two of the three periodontists were able to appraise the pain experienced by their patients, the third was not. CONCLUSIONS: It seems important that the periodontist at the first encounter with the patient should be sensitive to the discomfort the examination may entail. This may influence the patients' decision to accept the required treatment, and may also affect the patients' attitude to and co-operation with the subsequent treatment.     

Prevalence of endodontic infection in patients with Crohn´s disease and ulcerative colitis

Background Previous studies have linked apical periodontitis (AP) to inflammatory bowel disease (IBD). The aim of this study was to compare the prevalence of AP and root canal treatment (RCT) in patients with ulcerative colitis (UC) and Crohn´s disease (CD). Material and Methods A cross-sectional study, including 28 patients with Crohn´s disease and 26 with ulcerative colitis, was conducted. AP was diagnosed as radiolucent periapical lesions (RPLs), using the periapical index score (PAI). Student’s t test, 2 test and multivariate logistic regression were used in the statistical analysis. Results Multivariate logistic regression run with age, gender, number of teeth, number of RFT, periodontal disease and the type of IBD as covariates, taking as dependent variable and outcome “periapical status” (0 = no tooth with RPL; 1 = at least one tooth with RPL), showed that both UC and CD patients had the prevalence apical periodontitis (OR = 1.03; C.I. 95% = 0.25 – 4.31; p = 0.97). The multivariate analysis, including all the above covariates, shows that both in UC and CD patients the prevalence of RCT was similar (OR = 0.76; C.I. 95% = 0.17 – 7.31; p = 0.73). Periapical status was significantly associated with endodontic status (OR = 42.72; C.I. 95% = 3.87 – 472.15; p = 0.002), regardless of IBD type. Conclusions The results of the present study show similar frequency of AP and RFT in both UC and CD patients. The type of IBD does not appear to affect the prevalence of radiographically detectable periapical lesions or the prevalence of root canal treatment. Key words:Apical periodontitis, Crohn’s disease, inflammatory bowel disease, toot canal treatment, ulcerative colitis.