Elsevier

Journal of Endodontics

Volume 38, Issue 1, January 2012, Pages 41-46
Journal of Endodontics

Clinical Research
Incidence and Impact of Painful Exacerbations in a Cohort with Post-treatment Persistent Endodontic Lesions

https://doi.org/10.1016/j.joen.2011.10.006Get rights and content

Abstract

Introduction

Painful exacerbations of persistent periapical lesions have unknown incidence and impact on quality of life. This study examined the incidence and impact of painful exacerbations and evaluated potential predictive factors of pain associated with root-filled teeth with persistent lesions after root canal treatment.

Methods

Patients from a university hospital clinic were screened to identify root-filled teeth with periapical lesions at time of treatment and not resolved at least 4 years later. A clinical and radiographic examination and questionnaire survey were conducted. Patient and treatment characteristics and details of pain experience were studied. Statistical analysis was carried out by using SPSS (version 18).

Results

One hundred twenty-seven patients with 185 persistent lesions were recruited. Median age of patients at recruitment was 56 years (range, 21–82 years). Median time since treatment was 5 years (range, 4–38 years). Overall incidence of flare-up (requiring an unscheduled dental visit) was only 5.8% 20 years after treatment. Less severe pain was more frequent, with a combined incidence of 45% pain at 20 years after treatment. Female patients (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.2–6.0; P < .05), treatment involving a mandibular molar or maxillary premolar (OR, 3.7; 95% CI, 1.6–8.6; P < .05), and preoperative pain (OR, 2.9; 95% CI, 1.3–6.7; P < .05) were significantly associated with pain after treatment. The most commonly affected activities during painful exacerbations were eating and tooth brushing, with minimal impact on daily living.

Conclusions

The risk of flare-up among persistent lesions was very low. A lower degree of pain was more common, but generally with minimal impact on daily activities.

Section snippets

Overview

This study received approval from the Institutional Review Board of the National University of Singapore (NUS IRB Reference Code 10-171). Patient records of all root canal treatments performed in National University Hospital Singapore clinics from 2004–2006 were hand-searched from July 2010–February 2011 to identify root-filled teeth with periapical radiolucencies present at the time of treatment and not resolved at short-term recall (6–12 months). These patients (at least 21 years of age at

Calibration of Examiners

The calibration process yielded weighted Cohen kappa scores of 0.716 for interexaminer reliability and 0.638 and 0.821 for intraexaminer reliability. Patient and treatment characteristics are shown in Table 1.

From the initial sample of 464 patients, 193 (41.6%) responded to the invitation to attend the recall clinic. From these patients, 185 teeth in 127 patients were recruited into the study as meeting the selection criteria. Teeth were quite evenly distributed between 61 female and 66 male

Discussion

In this recall study, the data regarding pain experience relied mostly on patients’ recollection. Only flare-ups resulting in an unscheduled dental visit could be confirmed from the patient records. Nonetheless, pain episodes were considered to be reliable points of reference for patients’ recollection of pain impact on daily activities. Recollection of an acute episode of pain intensity was previously found to be more reliable than the recollection of chronic pain (18). In the acute pain

Acknowledgments

The authors thank Associate Professor Stephen Hsu Chin-ying from National University of Singapore for his contribution in the study design.

The authors deny any conflicts of interest related to this study.

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    Supported by the Singapore Ministry of Education, Research Grant WBS no. R224-000-038-133.

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