Pain Correlates in Endodontic Procedures: A Narrative Review Examining the Causative Factors and Clinical Approaches for Management.

Authors

  • Haider Al-Saffar MPharm, BDS, MJDF MFDS RCS(Eng), MCGDent, PGCertTLCP, FHEA General Dental Practitioner, Educational Supervisor and Pharmacist, United Kingdom.

DOI:

https://doi.org/10.55677/IJCSMR/V4I3-02/2024

Keywords:

dental pain, endodontics, pain, pain management, root canal, root filling

Abstract

Endodontic treatment, encompassing the diagnosis and management of dental pulp and periapical conditions, is pivotal in preserving dental health. Root canal treatment, a common endodontic procedure, involves the removal, cleaning, and sealing of the tooth's root system to address issues like pain and infections. Patients undergoing endodontic procedures often encounter pain due to the sensitivity of dental pulp nerves to caries, inflammation, infections, or treatment manipulations. The severity of pain is variable and influenced by individual factors such as pain threshold, anxiety levels, gender, and the extent of dental infection.

In conclusion, despite advancements in endodontics, pain management remains a significant concern. The narrative review emphasizes the importance of adopting comprehensive clinical management strategies encompassing the entire treatment process. A thorough assessment of the patient's medical history and dental condition is crucial to identify risk factors for increased pain. Effective communication with patients regarding the procedure and potential discomfort aids in managing expectations and reducing anxiety. Continuous professional development is highlighted as essential for dental professionals to stay abreast of the latest advancements, enabling the implementation of optimal pain management strategies and the delivery of enhanced patient care.

References

American Association of Endodontists. (2019, June 3). Guide to Clinical Endodontics - American Association of Endodontists.

https://www.aae.org/specialty/clinical-resources/guide-clinical-endodontics/

Schilder, H. (1967). Cleaning and shaping the root canal. Dental Clinics of North America, 723–744. https://doi.org/10.1016/S0011-8532(67)80001-6

Leclaire, A., Skidmore, A. E., Griffin, J. D., & Balaban, F. S. (1988). Endodontic fear survey. Journal of Endodontics, 14(11), 560–564. https://doi.org/10.1016/s0099-2399(88)80091-8

Fan, B., & Gutmann, J. L. (2016). Tooth Morphology, Isolation, and Access. In Cohen’s Pathways of the Pulp. (11th ed., pp. 130–133). St. Louis, MO: Elsevier.

Siqueira, J. F., Rôças, I. N., Favieri, A., Machado, A. Q., Gahyva, S. M., Oliveira, J. C. R. F., & Da Costa Abad, E. (2002). Incidence of postoperative pain after intracanal procedures based on an antimicrobial strategy. Journal of Endodontics, 28(6), 457–460.

https://doi.org/10.1097/00004770-200206000-00010

Pak, J. G., & White, S. N. (2011). Pain Prevalence and Severity before, during, and after Root Canal Treatment: A Systematic Review. Journal of Endodontics, 37(4), 429–438. https://doi.org/10.1016/j.joen.2010.12.016

Khan, S., Hamedy, R., Lei, Y., Ogawa, R., & White, S. N. (2016). Anxiety Related to Nonsurgical Root Canal Treatment: A Systematic Review. Journal of Endodontics, 42(12), 1726–1736.

https://doi.org/10.1016/j.joen.2016.08.007

Dou, L., Vanschaayk, M. M., Zhang, Y., Fu, X., Ji, P., & Yang, D. (2018). The prevalence of dental anxiety and its association with pain and other variables among adult patients with irreversible pulpitis. BMC Oral Health, 18(1).

https://doi.org/10.1186/s12903-018-0563-x

Jain, N., Gupta, A., & Meena, N. (2013). An Insight Into Neurophysiology of Pulpal Pain: Facts and Hypotheses. The Korean Journal of Pain, 26(4), 347–355. https://doi.org/10.3344/kjp.2013.26.4.347

Hargreaves, K. M., Swift, J. H., Roszkowski, M. T., Bowles, W. R., Garry, M. G., & Jackson, D. L. (1994). Pharmacology of peripheral neuropeptide and inflammatory mediator release. Oral Surgery, Oral Medicine, Oral Pathology, 78(4), 503–510. https://doi.org/10.1016/0030-4220(94)90045-0

Dubin, A. E., & Patapoutian, A. (2010). Nociceptors: the sensors of the pain pathway. Journal of Clinical Investigation, 120(11), 3760–3772. https://doi.org/10.1172/jci42843

Närhi, M. (1985). The Characteristics of Intradental Sensory Units and Their Responses to Stimulation. Journal of Dental Research, 64(4), 564–571. https://doi.org/10.1177/002203458506400411

Murillo-Benítez, M., Martín-González, J., Jiménez‐Sánchez, M. C., Cabanillas-Balsera, D., Velasco-Ortega, E., & Segura-Egea, J. J. (2020). Association between dental anxiety and intraoperative pain during root canal treatment: a cross‐sectional study. International Endodontic Journal, 53(4), 447–454. https://doi.org/10.1111/iej.13245

Carter, A. C., Carter, G., Boschen, M. J., AlShwaimi, E., & George, R. (2014). Pathways of fear and anxiety in dentistry: A review. World Journal of Clinical Cases, 2(11), 642.

https://doi.org/10.12998/wjcc.v2.i11.642

Seligman, L. D., Hovey, J. D., Chacon, K., & Ollendick, T. H. (2017). Dental anxiety: An understudied problem in youth. Clinical Psychology Review, 55, 25–40.

https://doi.org/10.1016/j.cpr.2017.04.004

Freeman, R. (1991). The role of memory on the dentally anxious patient’s response to dental treatment. Irish Journal of Psychological Medicine, 8(2), 110–115.

https://doi.org/10.1017/s0790966700015019

Daline, I. H., Slade, G. D., Fouad, A. F., Nixdorf, D. R., & Tchivileva, I. E. (2023). Prevalence of painful temporomandibular disorders in endodontic patients with tooth pain. Journal of Oral Rehabilitation. https://doi.org/10.1111/joor.13457

Sahebi, S., Moazami, F., Afsa, M., & Zade, M. H. (2010). Effect of lengthy root canal therapy sessions on temporomandibular joint and masticatory muscles. PubMed. https://doi.org/10.5681/joddd.2010.024

Segura-Egea, J. J., Cabanillas-Balsera, D., Martín-González, J., & Cintra, L. T. A. (2022). Impact of systemic health on treatment outcomes in endodontics. International Endodontic Journal, 56(S2), 219–235.

https://doi.org/10.1111/iej.13789

Alroomy, R., Kim, D., Hochberg, R., Chubak, J., Rosenberg, P. B., & Malek, M. J. (2020). Factors influencing pain and anxiety before endodontic treatment: A cross-sectional among American individuals. European Endodontic Journal.

https://doi.org/10.14744/eej.2020.17363

Jayakodi, H., Kailasam, S., Kumaravadivel, K., Thangavelu, B., & Mathew, S. (2012). Clinical and pharmacological management of endodontic flare-up. Journal of Pharmacy and Bioallied Sciences, 4(6), 294. https://doi.org/10.4103/0975-7406.100277

Bender, I. (2000). Pulpal Pain Diagnosis—A Review. Journal of Endodontics, 26(3), 175–179. https://doi.org/10.1097/00004770-200003000-00012

Abd-Elmeguid, A., & Yu, D. C. (2009). Dental Pulp Neurophysiology: Part 1. Clinical and Diagnostic Implications. Journal of the Canadian Dental Association, 75(1).

https://www.cda-adc.ca/jcda/vol-75/issue-1/55.html

Tanalp, J., & Gungor, T. (2014). Apical extrusion of debris: a literature review of an inherent occurrence during root canal treatment. International Endodontic Journal, 47(3), 211–221.

https://doi.org/10.1111/iej.12137

Bassam, S., El-Ahmar, R., Salloum, S., & Ayoub, S. (2021). Endodontic postoperative flare-up: An update. The Saudi Dental Journal, 33(7), 386–394. https://doi.org/10.1016/j.sdentj.2021.05.005

Siqueira, J. F. (2003). Microbial causes of endodontic flare-ups. International Endodontic Journal, 36(7), 453–463.

https://doi.org/10.1046/j.1365-2591.2003.00671.x

Naoum, H. J., & Chandler, N. P. (2002). Temporization for endodontics. International Endodontic Journal, 35(12), 964–978.

https://doi.org/10.1046/j.1365-2591.2002.00600.x

Siqueira, J. F., & Barnett, F. (2004). Interappointment pain: mechanisms, diagnosis, and treatment. Endodontic Topics, 7(1), 93–109.

https://doi.org/10.1111/j.1601-1546.2004.00062.x

Gondim, E., Setzer, F. C., Carmo, C. B. D., & Kim, S. (2010). Postoperative Pain after the Application of Two Different Irrigation Devices in a Prospective Randomized Clinical Trial. Journal of Endodontics, 36(8), 1295–1301.

https://doi.org/10.1016/j.joen.2010.04.012

Hawker, G. A., Mian, S., Kendzerska, T., & French. (2011). Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF. Arthritis Care and Research, 63(S11), S240–S252.

https://doi.org/10.1002/acr.20543

Nair, P. N. R. (2006). On the causes of persistent apical periodontitis: a review. International Endodontic Journal, 39(4), 249–281.

https://doi.org/10.1111/j.1365-2591.2006.01099.x

Fedorowicz, Z., Nasser, M., Sequeira-Byron, P., De Souza, R. F., Carter, B., & Heft, M. W. (2012). Irrigants for non-surgical root canal treatment in mature permanent teeth. The Cochrane Library. https://doi.org/10.1002/14651858.cd008948.pub2

Onay, E. O., Üngör, M., & Yazici, A. (2015). The evaluation of endodontic flare-ups and their relationship to various risk factors. BMC Oral Health, 15(1). https://doi.org/10.1186/s12903-015-0135-2

Bashetty, K., & Hegde, J. (2010). Comparison of 2% chlorhexidine and 5.25% sodium hypochlorite irrigating solutions on postoperative pain: A randomized clinical trial. Indian Journal of Dental Research, 21(4), 523. https://doi.org/10.4103/0970-9290.74225

Farzaneh, S., Parirokh, M., Nakhaee, N., & Abbott, P. V. (2018). Effect of two different concentrations of sodium hypochlorite on postoperative pain following single-visit root canal treatment: a triple-blind randomized clinical trial. International Endodontic Journal, 51, e2–e11.

https://doi.org/10.1111/iej.12749

Mostafa, M. E. H. a. A., El‐Shrief, Y. a. I., Anous, W. H., Hassan, M. K., Salamah, F. T. A., Boghdadi, R. M. E., El‐Bayoumi, M. a. A., Seyam, R., Abd‐El‐Kader, K. G., & Amin, S. a. W. (2020). Postoperative pain following endodontic irrigation using 1.3% versus 5.25% sodium hypochlorite in mandibular molars with necrotic pulps: a randomized double‐blind clinical trial. International Endodontic Journal, 53(2), 154–166.

https://doi.org/10.1111/iej.13222

Aoun, C., El Osta, N., Naaman, A., Zogheib, C., & Khalil, I. (2019). Post-endodontic Flare-ups after a Single-visit Treatment Using the FUI Scoring Method and Associated Factors: A Clinical Prospective Study. The Journal of Contemporary Dental Practice, 20(9), 1033–1040.

Shresha, R., Shrestha, D., & Kayastha, R. (2018). Post-Operative Pain and Associated Factors in Patients Undergoing Single Visit Root Canal Treatment on Teeth with Vital Pulp. Kathmandu University Medical Journal (KUMJ), 16(62), 220–223.

Vieyra, J. P., Enriquez, F. J. J., Acosta, F. O., & Guardado, J. (2019). Reduction of postendodontic pain after one-visit root canal treatment using three irrigating regimens with different temperature. PubMed, 22(1), 34–40.

https://doi.org/10.4103/njcp.njcp_349_18

Ingadottir, B., & Zoëga, S. (2017). Role of patient education in postoperative pain management. Nursing Standard, 32(2), 50–63.

https://doi.org/10.7748/ns.2017.e10939

Facd, L. H. B. D., & Hargreaves, K. M. (2015). Cohen’s Pathways of the Pulp Expert Consult. Elsevier Health Sciences.

Segura-Egea, J. J., Cisneros-Cabello, R., Llamas-Carreras, J. M., & Velasco-Ortega, E. (2009). Pain associated with root canal treatment. International Endodontic Journal, 42(7), 614–620.

https://doi.org/10.1111/j.1365-2591.2009.01562.x

Keiser, K., & Hargreaves, K. M. (2002). Building effective strategies for the management of endodontic pain. Endodontic Topics, 3(1), 93–105.

https://doi.org/10.1034/j.1601-1546.2002.30109.x

Walton, R. I. (2002). Interappointment flare-ups: incidence, related factors, prevention, and management. Endodontic Topics, 3(1), 67–76.

https://doi.org/10.1034/j.1601-1546.2002.30107.x

Plotino, G., Grande, N. M., Melo, M., De Azevedo Bahia, M. G., Testarelli, L., & Gambarini, G. (2010). Cyclic fatigue of NiTi rotary instruments in a simulated apical abrupt curvature. International Endodontic Journal, 43(3), 226–230.

https://doi.org/10.1111/j.1365-2591.2009.01668.x

Testarelli, L., Plotino, G., Al-Sudani, D., Vincenzi, V., Giansiracusa, A., Grande, N. M., & Gambarini, G. (2011). Bending Properties of a New Nickel-Titanium Alloy with a Lower Percent by Weight of Nickel. Journal of Endodontics, 37(9), 1293–1295. https://doi.org/10.1016/j.joen.2011.05.023

Al-Sudani, D., Grande, N. M., Plotino, G., Pompa, G., Di Carlo, S., Testarelli, L., & Gambarini, G. (2012). Cyclic Fatigue of Nickel-Titanium Rotary Instruments in a Double (S-shaped) Simulated Curvature. Journal of Endodontics, 38(7), 987–989. https://doi.org/10.1016/j.joen.2012.03.025

Kishen, A., Peters, O. A., Zehnder, M., Diogenes, A. R., & Nair, M. (2016). Advances in endodontics: Potential applications in clinical practice. Journal of Conservative Dentistry, 19(3), 199.

https://doi.org/10.4103/0972-0707.181925

Figini, L., Lodi, G., F, G., & Gagliani, M. (2008). Single Versus Multiple Visits for Endodontic Treatment of Permanent Teeth: A Cochrane Systematic Review. Journal of Endodontics, 34(9), 1041–1047. https://doi.org/10.1016/j.joen.2008.06.009

Riaz, A., Maxood, A., Abdullah, S., Saba, K., Ud Din, S., & Zahid, S. (2018). Comparison of frequency of post-obturation pain of single versus multiple visit root canal treatment of necrotic teeth with infected root canals. A Randomized Controlled Trial. Journal of the Pakistan Medical Association, 68(10), 1429–1433.

https://jpma.org.pk/article-details/8878?article_id=8878

Nair, M., Rahul, J., Devadathan, A., & Mathew, J. (2017). Incidence of Endodontic Flare-ups and Its Related Factors: A Retrospective Study. PubMed,

(4), 175–179.

https://doi.org/10.4103/jispcd.jispcd_61_17

Ehrmann, E. H., Messer, H. H., & Adams, G. S. (2003). The relationship of intracanal medicaments to postoperative pain in endodontics. International Endodontic Journal, 36(12), 868–875.

https://doi.org/10.1111/j.1365-2591.2003.00735.x

Eftekhar, B., Moghimipour, E., Jahandideh, P. P., Jalali, S., & Mahmoudian, M. (2013). Analgesic Effect of Odontopaste and a Compound Intracanal Medicament Between Root Canal Therapy Appointments. Jundishapur Journal of Natural Pharmaceutical Products, 8(4), 169–174.

https://doi.org/10.17795/jjnpp-12473

Al-Saffar, H. A., & Dadnam, D. (2021). Ledermix in children. British Dental Journal, 230(5), 273. https://doi.org/10.1038/s41415-021-2796-3

Smith, E. A., Marshall, J. G., Selph, S., Barker, D., & Sedgley, C. M. (2017). Nonsteroidal Anti-inflammatory Drugs for Managing Postoperative Endodontic Pain in Patients Who Present with Preoperative Pain: A Systematic Review and Meta-analysis. Journal of Endodontics, 43(1), 7–15. https://doi.org/10.1016/j.joen.2016.09.010

Becker, D. J. (2010). Pain Management: Part 1: Managing Acute and Postoperative Dental Pain. Anesthesia Progress, 57(2), 67–79.

https://doi.org/10.2344/0003-3006-57.2.67

AAE Guidance on the Use of Systemic Antibiotics in Endodontics. (2017). In American Association of Endodontics. https://www.aae.org/specialty/wp-content/uploads/sites/2/2017/06/aae_systemic-antibiotics.pdf

Shamszadeh, S., Shirvani, A., Eghbal, M. J., & Asgary, S. (2018). Efficacy of Corticosteroids on Postoperative Endodontic Pain: A Systematic Review and Meta-analysis. Journal of Endodontics, 44(7), 1057–1065.

https://doi.org/10.1016/j.joen.2018.03.010

Downloads

Published

2024-03-06

How to Cite

Haider Al-Saffar. (2024). Pain Correlates in Endodontic Procedures: A Narrative Review Examining the Causative Factors and Clinical Approaches for Management. International Journal of Clinical Science and Medical Research, 4(3), 77–83. https://doi.org/10.55677/IJCSMR/V4I3-02/2024