Influence of preoperative pain intensity on postoperative pain after root canal treatment: A prospective clinical study
Introduction
Pain control, both during and after root canal treatment, is a key aspect of endodontic practice [1]. Postoperative pain following root canal treatment can be embarrassing for the dentist and annoying for the patient, especially if the tooth was symptom-free before the treatment began.
Postoperative pain of low and mild intensity is common, even when the endodontist has followed acceptable standards of treatment [2]. According to a recently published systematic review, between 3% and 58% of patients reported pain after root canal treatment [3]. The discrepancies among studies may be partly explained by the fact that most of the authors assessed and defined postoperative pain according to different criteria, used different endodontic materials and techniques, or did not take preoperative pain intensity into account as a variable [4].
Postendodontic pain is multifactorial [5]: it is linked to a periapical inflammatory response secondary to mechanical, chemical and/or microbial injury to the periradicular tissues [3], [6], [7], [8], [9].
Postoperative pain most often occurs during the first 24–48 h after obturation, and generally recedes in a few hours [10], [11], [12], although it occasionally persists for several days [5], [13], [14].
The strong evidence of a correlation between preoperative and postoperative pain demonstrates that patients experiencing preoperative pain tend to have a higher intensity of postoperative pain when compared with patients who had no preoperative symptoms [6], [11], [15], [16], [17].
There is some disagreement in the literature on the correlation between pulpal status and postoperative pain. Some authors suggest that pulpal status has an influence on postoperative pain [4], [6], [18], while others [11], [19], [20] found no evidence of any influence between these two factors.
Some authors [4], [11], [15], [16], [18] investigated the correlation between specific variables (patient age, sex, arch, tooth vitality, and the presence of preoperative pain) on the prevalence of postoperative pain. However, in these studies, the investigators recorded the presence or absence of preoperative pain regardless of its intensity. To our knowledge, only two studies [21], [22] have quantified preoperative pain before root canal treatment. Therefore the aim of this study was to investigate the correlation between preoperative pain intensity with a view to measuring its influence on the prevalence of postoperative pain by taking into account the variables sex, tooth type, arch, and tooth vitality.
Section snippets
Materials and methods
This prospective study was conducted in patients with pulpal pathology who were scheduled for routine endodontic treatment at the Restorative Dentistry and Endodontics Department of Universitat Internacional de Catalunya (Sant Cugat del Vallés, Barcelona, Spain). The study was approved by the Institutional Ethics in Research Committee.
Results
A total of 270 patients took part in this study: 151 (55.9%) were women, and 119 (44.1%) were men. Their ages ranged between 18 and 71 years; 188 (69.6.%) of the treated teeth were in the maxilla, and 82 (30.4%) were in the mandible. Fifty-four teeth (20%) were located in the anterior segment. Eighty-five (31.5%) were premolars, and 131 (48.5%) were molars. Of the 270 patients, 128 (47.4%) were symptomatic and 142 (52.6%) were asymptomatic; 158 (58.5.%) of the treated teeth were vital, and 112
Discussion
The aim of this study was to assess the intensity of preoperative pain and the prevalence of postoperative pain after root canal treatment by correlating demographic and clinical variables. The results showed that patients with variables associated with more preoperative pain had a significantly higher prevalence of postoperative pain (P < .05).
Pain management should be an integral part of dental treatment, above all to prevent its exacerbation during postoperative stages. Because pain is known
References (29)
- et al.
Pain prevalence and severity before, during, and after root canal treatment: a systematic review
J. Endod.
(2011) - et al.
Postoperative pain in multiple-visit and single-visit root canal treatment
J. Endod.
(2010) - et al.
Incidence of postoperative pain after intracanal procedures based on an antimicrobial strategy
J. Endod.
(2002) - et al.
Incidence of pain associated with clinical factors during and after root canal therapy. Part 2. Postobturation pain
J. Endod.
(1983) - et al.
Flare up rate related to root canal treatment of asymptomatic pulpally necrotic central incisor teeth in patients attending a military hospital
J. Dent.
(2006) - et al.
Incidence and duration of pain following endodontic therapy. Relationship to treatment with sulfonamides and to other factors
Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod.
(1961) - et al.
Postoperative pain after manual and mechanical glide path: a randomized clinical trial
J. Endod.
(2012) Pain in endodontic therapy: preliminary study
J. Endod.
(1976)- et al.
Postoperative pain incidence related to the type of emergency treatment of symptomatic pulpitis
Oral Med. Oral Pathol.Oral Radiol. Endod.
(1992) - et al.
Postobturation pain and associated factors in adolescent patients undergoing one- and two-visit root canal treatment
J. Dent.
(2008)
Postoperative pain after foraminal enlargement in anterior teeth with necrosis and apical periodontitis: a prospective and randomized clinical trial
J. Endod.
Clinical strategies for managing endodontic pain
Endod. Topics
Interappointment pain: mechanisms, diagnosis, and treatment
Endod. Topics
The prevalence of postoperative pain and flare-up in single- and multiple-visit endodontic treatment: a systematic review
Int. Endod. J.
Cited by (82)
Evaluation of Pain Following the Use of Different Single-file Glide Path Systems: A Randomized Clinical Trial
2024, Journal of EndodonticsCalcium hydroxide as an intracanal medication for postoperative pain during primary root canal therapy: A systematic review and meta-analysis with trial sequential analysis of randomised controlled trials
2022, Journal of Evidence-Based Dental PracticeCitation Excerpt :There are multiple potential reasons for the substantial heterogeneity, including variations in the operators’ skill and experience, types of teeth, instrumentation techniques, irrigation protocol, use of different formulations of intracanal medicaments, preoperative pain, and pulpal and periapical status. The presence of preoperative pain is considered one of the most consistent variables that influences postoperative pain in root canal therapy.38, 43, 44 We found a high rate of severe postoperative pain and flare-up in some of our studies, most probably due to the inclusion criteria we used that was limited to apical periodontitis.
Effect of photobiomodulation on postoperative endodontic pain: A systematic review of clinical trials
2024, Dental Research Journal