Peri-Operative Pain and Root Canal Therapy

Pain following root canal therapy occurs commonly, with an incidence range of 3% to 58% depending on the definition. The majority of this post-endodontic pain is well controlled using current treatment modalities, but a small subset of patients seems to be resistant to treatment and experiences severe pain. Significant post-endodontic pain is commonly referred to as an endodontic flare-up and has been defined as severe pain that precipitates a patient-dentist interaction within one week of treatment initiation. Such pain, when associated with local soft tissue swelling, is known to occur in 3% of all cases of root canal therapy. Given that >16.4 million root canal therapies are performed every year within the US, about half a million patients experience severe pain that is resistant to treatment. This pain is known to cause significant amounts of dental anxiety and fear, which in turn is a major barrier to receiving dental care and can have other negative psychosocial consequences. For these reasons, it is important to understand the factors related to the development of endodontic flare-up pain in efforts to better treat this pain. Research on endodontic-related pain has suggested that (a) the intensity of pre-operative pain and (b) the experience of intra-operative pain are significant factors related to the subsequent development of persistent tooth pain. Therefore, the primary goal of this study is to assess the presence and magnitude of pre-operative and intra-operative tooth pain, and to determine how these factors are associated with the outcome of intense post-endodontic flare-up pain. The overall goal is to better understand how the experience of peri-operative pains relate to each other. The long-term goal of this line of research is to identify the modifiable pre-operative factors that put patients at greater risk of developing persistent tooth pain following root canal therapy, thereby providing evidence that will allow dentists to act preventively to mitigate this risk, improve pain control, increase their patients’ quality of life, and decrease the number of dental emergency interactions. Since future studies within the DPBRN will be required to achieve this long-term goal, the secondary goal of this study is to assess the feasibility of recruiting patients using the DPBRN and to pilot test a more detailed data collection procedure from both patients and practitioners using a small subset of practitioners and within the DPBRN.