Predicting Severe Pain after Root Canal Therapy in the National Dental PBRN

Abstract

Some patients experience severe pain following root canal therapy (RCT) despite advancements in care. We sought to identify factors, which can be measured preoperatively, that predict this negative outcome so that future research may focus on preemptive steps to reduce postoperative pain intensity. Sixty-two practitioners (46 general dentists and 16 endodontists) who are members of the National Dental Practice-Based Research Network enrolled patients receiving RCT for this prospective observational study. Baseline data collected from patients and dentists were obtained before treatment. Severe postoperative pain was defined based on a rating of ≥7 on a scale from 0 (no pain) to 10 (pain as bad as can be) for the worst pain intensity experienced during the preceding week, and this was collected 1 wk after treatment. Multiple logistic regression analyses were used to develop and validate the model. A total of 708 patients were enrolled during a 6-m period. Pain intensity data were collected 1 wk postoperatively from 652 patients (92.1%), with 19.5% (n = 127) reporting severe pain. In multivariable modeling, baseline factors predicting severe postoperative pain included current pain intensity (odds ratio [OR], 1.15; 95% confidence interval [CI], 1.07 to 1.25; P = 0.0003), number of days in the past week that the subject was kept from their usual activities due to pain (OR, 1.32; 95% CI, 1.13 to 1.55; P = 0.0005), pain made worse by stress (OR, 2.55; 95% CI, 1.22 to 5.35; P = 0.0130), and a diagnosis of symptomatic apical periodontitis (OR, 1.63; 95% CI, 1.01 to 2.64; P = 0.0452). Among the factors that did not contribute to predicting severe postoperative pain were the dentist's specialty training, the patient's age and sex, the type of tooth, the presence of swelling, or other pulpal and apical endodontic diagnoses. Factors measured preoperatively were found to predict severe postoperative pain following RCT. Practitioners could use this information to better inform patients about RCT outcomes and possibly use different treatment strategies to manage their patients (Clinicaltrials.gov NCT01201681).

The Outcome of Preoperative Administration of Single-Dose Ketorolac, Ibuprofen 400mg and Placebo on Postoperative Pain in Teeth with Irreversible Pulpitis and Apical Periodontitis

“…The results from this present study are consistent with the findings of Law [29] that to avoid severe postoperative pain in endodontic therapy, preemptive analgesia strategies before initiation of treatment are necessary and with Krasner & Jackson [31] who noted from their study that although pulpectomy eliminates endodontic pain, postoperative pain and discomfort. Two previous investigations have reported that the prophylactic use of analgesics at the end of the treatment visit had a positive influence on postoperative pain felt by the patients [10,32].…”

“…Know those factors as predictors may contribute to define preventive oral health strategies to manage this undesirable condition, minimizing pain incidence and/or intensity and reducing patient suffering at the individual and population levels. Additionally, clinicians may use this information to advise patients about pain outcomes related to RCT [29]. The results of the present study indicated that some clinicians were more likely to choose medication before and after endodontic treatment to manage this painful clinical scenario, whereas other educators and residents were much more likely to prescribe combination drugs in addition to instrumentation [30].…”

“…However, in cases of pulp necrosis with or without periradicular periodontitis the literature is more controversial. Although preoperative administration of analgesics has been found to be effective in reducing postoperative pain [29], there has been various studies related to the effect of the preoperative administration of antihistamines on postoperative pain.…”

Gender aspects in postoperative pain

“…Similarly, acute postoperative pain and trismus after third molar extraction did not differ by gender (n ¼ 150, n ¼ 100) [44,45]. Accordingly, gender could not predict acute pain after root canal therapy (n ¼ 708) [46], although acute pain events were reported more often in women; however, without statistical significance (n ¼ 140) [47]. Interestingly, in a large retrospective cohort study with 1671 patients submitted to surgical correction of mandibular deformities, seven women and no men developed neuropathic pain that persisted for a median of 52 days, suggesting that women are at higher risk for neuropathic pain after mandibular surgery [48].…”

Intraoperative discomfort associated with the use of a rotary or reciprocating system: a prospective randomized clinical trial

“…For this, a simple 1-to-10 VAS was used in the feedback evaluation, where 1 represented the ‘least possible discomfort’ and 10 represented the ‘greatest possible discomfort.’ This scale has been used in several clinical studies evaluating postoperative pain. Moreover, there is considerable evidence indicating that the VAS has advantages over other methods in terms of feasibility and reliability 101112…”