Frequency, impact, and predictors of persistent pain after root canal treatment

Nixdorf, Donald R.; Law, Alan S.; Lindquist, Kimberly; Reams, Gregory J.; Cole, Emery; Kanter, Keith; Nguyen, Ruby H.N.; Harris, D.R.

doi:10.1097/j.pain.0000000000000343

Cited by 63 publications

(74 citation statements)

References 29 publications

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“…Of those 354 patients, 38 (11%, 95% CI: 8-14%) met criteria for pain at 6 months following RCT and were considered eligible cases, which was slightly higher than 10.0% observed over the entire (“parent”) study population (3). Only subjects that had consented to be contacted were invited to participate in this study.…”

Section: Resultsmentioning

confidence: 86%

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Differential Diagnoses for Persistent Pain after Root Canal Treatment: A Study in the National Dental Practice-based Research Network

Nixdorf

Law

John

et al. 2015

Journal of Endodontics

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Introduction Pain present 6 months following root canal treatment (RCT) may be either of odontogenic or nonodontogenic origin. This is importance because treatments and prognoses are different; therefore the aim of this study was to provide specific diagnoses of patients reporting pain 6 months after receiving initial orthograde RCT. Methods We enrolled patients from the Midwest region of an existing prospective observational study of pain after RCT. Pain at 6 months was defined as ≥1 day of pain and average pain intensity of at least 1/10 over the preceding month. An Endodontist and an Orofacial Pain practitioner independently performed clinical evaluations, which included periapical and cone-beam CT radiographs, to determine diagnoses. Results Thirty-eight out of the 354 eligible patients in the geographic area (11%) met the pain criteria, with 19 (50%) consenting to be clinically evaluated. As the sole reason for pain, 7 patients (37%) were given odontogenic diagnoses (4 involving the RCT tooth, 3 involving an adjacent tooth). Eight patients (42%) were given nonodontogenic pain diagnoses (7 from referred temporomandibular disorder (TMD) pain, 1 from persistent dentoalveolar pain disorder (PDAP)). Two patients (11%) had both odontogenic and nonodontogenic diagnoses, while 2 (11%) no longer fit the pain criteria at the time of the clinical evaluation. Conclusion Patients reporting “tooth” pain 6 months following RCT had a nonodontogenic pain diagnosis accounting for some of this pain, with TMD being the most frequent nonodonotgenic diagnosis. Dentists should have the necessary knowledge to differentiate between these diagnoses to adequately manage their patients.

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Section: Resultsmentioning

confidence: 86%

“…Persistent pain after RCT is known to occur and is not an uncommon event, being estimated by meta-analysis to be 5.4% (2) and by prospective observation to be 10.0% at 6 months following RCT (3). Taxonomy of diagnoses underlying persistent pain after RCT can be broadly classified as either odontogenic (4) or nonodonogentic (5) in etiology.…”

Section: Introductionmentioning

confidence: 99%

Differential Diagnoses for Persistent Pain after Root Canal Treatment: A Study in the National Dental Practice-based Research Network

Nixdorf

Law

John

et al. 2015

Journal of Endodontics

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“…The present report is based on secondary analyses of data originally collected. The original study was designed to prospectively assess outcomes following root canal treatment (RCT), and details of study methods (18) and outcomes (19–22) have been previously reported. In brief, 62 dentists (46 general practitioners and 16 endodontic specialists) from 5 regions (Alabama/Mississippi, Florida/Georgia, Minnesota, Oregon/Washington, and Denmark/Sweden) participated by collecting observational data from endodontic patients in their practices.…”

Section: Methodsmentioning

confidence: 99%

Validity of Preoperative Clinical Findings to Identify Dental Pulp Status: A National Dental Practice-Based Research Network Study

Pigg

Nixdorf

Nguyen

et al. 2016

Journal of Endodontics

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Introduction Endodontic diagnostic tests are often used clinically to assess pulp status as a basis for diagnosis and determination of whether root canal treatment (RCT) is indicated. Response to cold and pain on percussion are two common tests, yet their validity in identifying non-vital pulp in regular dental practice has not been reported. Methods We assessed the validity of cold and percussion tests to identify non-vital pulp in teeth requiring RCT in a dental practice setting, performed by 46 general dentists and 16 endodontists in the National Dental Practice-Based Research Network. The influence of patient-, tooth- and dentist-related characteristics was investigated. Observed bleeding from the pulp chamber was the clinical reference. Sensitivity (SN), specificity (SP), overall test accuracy (TA), positive (PPV) and negative (NPV) predictive values, and likelihood and diagnostic odds ratios (LR+, LR−, dOR) were calculated for each single test and the combined cold and percussion tests. Results 708 patient-teeth were included. Cold test showed high validity to identify a non-vital pulp status (SN 89%, SP 80%, TA 84%, PPV 81%, NPV 88%, LR+ 4.35, LR− 0.14, dOR 31.4), while pain on percussion had lower validity (SN 72%, SP 41%, TA 56%, PPV 54%, NPV 60%, LR+ 1.22, LR− 0.69, dOR 1.78). Combining the two tests did not increase validity, while preoperative pain, medication intake, patient age and gender, and dentist training level affected test validity significantly. Conclusion In regular dental practice, cold test exhibits higher validity to discriminate between vital and non-vital pulp than does tooth percussion test.

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“…A prospective study of pain before and after RCT concluded that 10% of the patients still experienced pain 6 months post‐treatment (Nixdorf et al . ). In a retrospective study, 45% of patients had experienced painful episodes from a root filled tooth with a persisting endodontic lesion up to 20 years post‐treatment (Yu et al .…”

Section: Introductionmentioning

confidence: 97%

“…, Nixdorf et al . ), and also attempted to identify the cause of such pain (e.g. remaining infection or nonodontogenic pain) (Nixdorf et al .…”

Section: Introductionmentioning

confidence: 99%

The frequency and characteristics of pain and discomfort associated with root filled teeth: a practice‐based study

et al. 2019

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Aim To (i) 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; (ii) assess the association between symptoms and clinical and radiographic findings; and (iii) 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 of 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 estimating 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 1256 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 to P = 0.044). The average pain intensity was 2.1 on a (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.

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Frequency, impact, and predictors of persistent pain after root canal treatment

Cited by 63 publications

References 29 publications

Differential Diagnoses for Persistent Pain after Root Canal Treatment: A Study in the National Dental Practice-based Research Network

Differential Diagnoses for Persistent Pain after Root Canal Treatment: A Study in the National Dental Practice-based Research Network

Validity of Preoperative Clinical Findings to Identify Dental Pulp Status: A National Dental Practice-Based Research Network Study

The frequency and characteristics of pain and discomfort associated with root filled teeth: a practice‐based study

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