Elsevier

Journal of Dentistry

Volume 45, February 2016, Pages 39-42
Journal of Dentistry

Influence of preoperative pain intensity on postoperative pain after root canal treatment: A prospective clinical study

https://doi.org/10.1016/j.jdent.2015.12.002Get rights and content

Abstract

Objectives

The aim of this prospective study was to investigate the correlation between the intensity of preoperative pain and the presence of postoperative pain, taking into account the variables sex, tooth type, arch, and tooth vitality.

Methods

Two hundred and seventy patients with pulpal pathology who were scheduled for routine endodontic treatment were enrolled in this study. Conventional endodontic treatment was carried out in a single visit. The chemomechanical preparation of root canals was performed with ProTaper instruments, and canals were obturated with a warm gutta-percha obturation technique. A structured questionnaire was used to record data on sex, age, type of tooth, location and pulp diagnosis. Patients were asked to record their preoperative and postoperative pain using a 10-cm visual analogue scale (VAS). Postoperative pain and the need for analgesic consumption were assessed at 4, 8, 16, 24, 48 and 72 h post-treatment. The data were analyzed using the Mann–Whitney U and chi-square test, and the significance was set at P < .05.

Results

The mean level of pain after root canal treatment was 2.58 ± 2.80 on a VAS between 0 and 10. Variables that were associated with a higher preoperative pain intensity (female, mandible and molar) also had a higher value of postoperative pain (P > .05).

Conclusions

Within the limitations of this study, it can be concluded that the presence of preoperative pain is the variable that most influences the prevalence of postoperative pain.

Clinical significance

Pain management should be an integral part of dental treatment. The present study analyses the incidence of postoperative pain that should be expected by patients with different intensity of pain before root canal treatment.

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

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