Prediction/Treatment of Endodontic Pain

Objectives and Goals

  • Describe the different ways posttreatment pain have been measured.
  • Describe the factors that have been purported and proven to increase or decrease posttreatment endodontic pain.
  • Describe the effect of various intracanal medicaments on endodontic posttreatment pain.
  • Describe the effect of systemic antibiotics on the incidence and severity of endodontic posttreatment pain.
  • List and describe the incidence and severity of endodontic posttreatment pain in patients who present with none, mild, moderate, or severe pretreatment pain.
  • Define and give the incidence for  "Endodontic Flare Up".

O'Keefe EM.  Pain in endodontic therapy: preliminary study. J Endodon 1976;2:315-319.

Maddox, DL, Walton RE, Davis CO. Incidence of posttreatmentendodontic pain related to medicaments and other factors.  J Endodon 1977;3:447-52

Pekruhn RB.  Single-visit endodontic therapy: a preliminary clinical study. J Am Dent Assoc  1981;103:875-7

Mulhern JM, Patterson SS, Newton CW, Ringel AM. Incidence of postoperative pain after one-appoiontment endodontic treatment of asymptomatic pulpal necrosis in single-rooted teeth. J Endodon 1982;8:370-5

Oliet S.  Single-visit endodontics: A clinical study.  J Endodon 1983;9:147- 52

Roane JB, Dryden JA, Grimes EW. Incidence of postoperative pain after single and multiple visit endodontic procedures.  Oral Surg. 1983;55:68-72

Creech JL, Walton RE, Kaltenbach R.  Effect of occlusal reduction on endodontic pain. J Am Dent Assoc  1984;109:64-67.

Seymour RA, Meechan JG, Blair GS.  Postoperative pain after apicectomy. A clinical investigation.  Int Endo J 1986;19:242-247

Genet JM, Wesselink PR, Thoden Van Velzen SK.  The incidence of preoperative and postoperative pain in endodontic therapy.  Int Endo J 1986;19:221-229.

Genet JM, Wesselink PR, Thoden Van Velzen SK.  Preoperative and operative factors associated with pain after the first endodontic visit.  Int Endo J 1987;20:53-64

Hasselgren G, Reitt C.  Emergency pulpotomy: Pain relieving effect with and without the use of sedative dressings.  J Endodon  1989;15:254-6

Trope M. Relationship of intracanal medicaments to endodontic flare-ups.  Endod Dent Traumatol 1990;6:226-9

Trope M.  Flare-up rate of single -visit endodontics.  Int Endo J.  1991;24:24-27

Walton RE, Fouad A.  Endodontic Flare-ups: A prospective study of incidence and related factors.  J Endodon 1992;18:172-7

Oguntebi BR, DeSchepper, Taylor TS, White CL, Pink FE.  Postoperative pain incidence of emergency treatment of symptomatic pulpitis.  Oral Surg Oral Med Oral Radiol 1992;73:479-483

Walton RE, Chiappinelli J. Prophylactic penecillin: Effect on posttreatment symptoms following root canl treatment of asymptomatic periapical pathosis.  J Endodon 1993;19:466-70

Marshall JG, Liesinger AW.  Factors associated with endodontic posttreatment pain.  J Endodon 1993;19:573-5

Torabinejad M, Cymerman JJ, Frankton M, Lemon RR, Maggio JD, Schilder H.  Effectiveness of various medications on postoperative pain following complete instrumentation.  J Endodon 1994;20:345-54

Torabinejad M, Dorn SO, Eleazer PD, Frankson M, Jouhari B, Mullin RK Soluti,A  Effectiveness of various medications on postoperative pain following root canal obturation.  J Endodon 1994;20:427-31

Imura N, Zuolo ML.  Factors associated with endodontic flare-ups: a prospective study.  Int Endodod J 1995;28:261-65

Optional

Seltzer S, Bender IB, Ehrenreich J.  Incidence and duration of pain following endodontic therapy.  Oral Surg 14:74-82.

Clem W.  Posttreatment  endodontic pain. JADA  81:1166-1170.

August DS.  Managing the abscessed tooth: instrument and close? J Endodon 3:316-318.

August DS.  Managing the abscessed tooth:  instrument and close part 2.  J Endodon 8:364-366

Weine FS, Healey HJ, Theiss EP.  Endodontic emergency dilemma: leave tooth open or keep it closed?  Oral Surg 1975;40:531-536.

Dorn SO, Moodnik RM, Feldman MJ, Borden BG.  Treatment of the endodontic emergency: a report based on a questionaire-part I.  J Endodon 1977;3:94-100.

Dorn SO, Moodnik RM, Feldman MJ, Borden BG. Treatment of the endodontic emergency: a report based on a questionaire-part II.  J Endodon 1977;3:153-156.

Morse DR, Furst ML, Belott RM, Lefkowitz RD, Spritzer IB, Sideman BH.  Infectious flare-ups and serious sequelae following endodontic treatment:  A prospective randomized trial on efficacy of antibiotic prophylaxis in cases of asymptomatic pulpal-periapical lesions.  Oral Surg 1987;64:96-109

Jostes JL, Holland GR.  The effect of occlusal reduction after canal preparation on patient comfort.  J Endodon 1984;10:34-7

Harrison JW, Baumgartner JC, Svec TA.  Incidence of pain associated with clinical factors during and after root canal therapy. Part 1. interappointment pain.  J Endodon 1983;9:384-7

Harrison JW, Baumgartner JC, Svec TA.  Incidence of pain associated with clinical factors during and after root canal therapy. Part 2. postobturation pain.  J Endodon 9:434-8

Harrison JW, Baumgartner JC, Zielke DR. Analysis of interappointment pain associated with the combined use of irrigants and medicaments. J Endodon  1981;7:272-6

Harrison JW, Bellizzi R, Osetek EM. The clinical toxicity of endodontic medicaments.  J Endodon 1979;5:42-7        

Fox J, Atkinson JS, Dinin AP, Greenfield E, Hechtman E, Reeman CA, Salkind M, Todaro CJ.  Incidence of pain following one-visit endodontic treatment.  Oral Surg 1970;30:123-130.

Peters DD.  Evaluation of prophylactic alveolar trephination to avoid pain.  J Endodon 1980;6:518-526.

Balaban FS, Skidmore AE, Griffin JA.  Acute exacerbations following initial treatment of necrotic pulps.  J Endodon  1984;10:78-81

Torabinejad M, Kettering JD, McGraw JC, Cummings RR, Dwyer TG, Tobias TS.  Factors associated with endodontic interappointment emergencies of teeth with necrotic pulps.  J Endodon 1988;14:261-265

Part II

Tkouyz LZG, Marchand S.  The influence of postoperative telephone calls on pain perception:A study of 118 perriodontal surgical procedures.  J Orofacial Pain 1998;12:219-225

Rosenberg PA, Babick PJ, Schertzer L, Leung A.  The effect of occlusal reduction on pain after endodontic instrumentation. J Endodon 1998;24:492-496

Ehlers L.  Pain and new cultural diseases.  Endod Dent Traumatol  1999;15:193-197

Gallatin E, Reader A, Nist R, Beck M.  Pain reduction in untreated irreversible pulpitis using an intraosseous injection of depo-medrol.  J Endodon 2000;26:633 638

Houck V, Reader A, Beck M, Nist R, Weaver J.  Effect of trephination on postoperative pain and swelling in symptomatic necrotic teeth.  Oral Surg Oral Pathol Oral Med  2000;90:507-513

Kvist T, Reit C.  Postoperative discomfort associated with surgical and nonsurgical endodontic retreatment.  Endod Dent Traumatol 2000;16:71-74

Nist E, Reader A, Beck M.  Effect of apical trephination on postoperative pain and swelling in symptomatic necrotic teeth.  J Endodon 2001;27:415-420

Mattscheck DJ, Law AS, Noblett WC.  Retreatment versus intitial root canal treatment: Factors affecting posttreatment pain.  Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;92:321-324

Alacam T, Tinaz AC.  Interappointment emergencies in teeth with necrotic pulps.  J Endodon 2002;28:375-377

Nusstein JM, Reader A, Beck M.  Effect of drainage upon access on postoperative endodontic pain and swelling in symptomatic necrotic teeth.  J Endodon 2002;28:584-588

DiRenzo A, Gresla T, Johnson BR, Rogers M, Tucker D, Begole EA.  Postoperative pain after 1- and 2-visit root canal therapy.  Oral Surg 2002;93:605-610

Watkins CA, Logan HL, Kirchner HL.  Anticipated and experienced pain associated with endodontic therapy.  J Am Dent Assoc  2002;133:45-54

Tsesis I, Fuss Z, Lin S, Tilinger G, Peled M.  Analysis of postoperative symptoms following surgical endodontic treatment.  Quintessence Int 2003;34:756-760

2004 Glennon JP, Ng YL, Setchell DJ, Gulabivala K.  Prevalence of and factors affecting postpreparation pain in patients undergoing two-visist root canal treatment.  Int Endodod J 2004;37:29-37

Ng YL, glennon JP, Setchell DJ, Gulabivala K.  Prevalence of and factors affecting post-obturation pain in patients undergoing root canal treatment.  Int Endodon J 2004;37:382-391

Menhinick KA, Gutmann JL, Regan JD, Taylor SE, Buschang PH.  The efficacy of pain control following nonsurgical root canal treatment using ibuprofen and acetaminophen in a randomized, double-blind, placebo-controlled study.  Int Endodon J 2004;37:531-541

Yoldas O, Topuz A, Isci AS, Oztunc H.  Postoperative pain after endodontic retreatment: Single – versus two-visit treatment.  Oral Surg Oral Med Oral Pathol Oral Radiol Endod  2004:98:483-7

Polycarpou N, Ng YL, Canavan D, Moles DR, Gulabivala K.  Prevalence of persistent pain after endodontic treatment and factors affecting its occurrence in cases with complete radiographic healing.  Int Endod J 2005;38:169-178

Chong BS, Pitt Ford TR.  Postoperative pain after root-end resection and filling.  Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;100:62-66

Wadachi R, Hargreaves KM.  Trigeminal nociceptors express TLR-4 and CD14: a mechanism for pain due to infection.  J Dent Res 2006;85:49-53

Hargreaves KM, Seltzer S.  Pharmacologic control of dental pain. In: Hargreaves KM, Goodis H, eds. Seltzer and Bender’sDental Pulp. Chicago:Quintessence Pub. 2002 Chapt 9 :211-221

Optional

Seltzer S, Naidorf IJ.  Flare-ups in endodontics: I. Etiological factors.  J Endodon 11:472-478.

Seltzer S, Naidorf IJ. Flare-ups in endodontics: II. Therapeutic measures.  J Endodon 11:559-567.

Morse DR, Koren LZ, Esposito JV, Goldberg JM, Belott RM, Sinai IH, Furst ML.  Asymptomatic teeth with necrotic pulps and associated periapical radiolucencies: Instrumentation, antibiotic usage and stress in three separate practices at three different time periods Part 1:1963-1970.  Int J Psychosomatics  33:5-17

Morse DR, Koren LZ, Esposito JV, Goldberg JM, Belott RM, Sinai IH, Furst ML.  Endodontic flare-ups: induction and prevention, Part 2: 1978-1983. Int J Psychosomatics  33:18-30

Elliott JA, Holcomb JB.  Evaluation of a minimally traumatic alveolar trephination procedure to avoid pain.  J Endodon 14:405-7

Barnett F, Tronstad L.  The incidence of flare-ups following endodontic treatment. J Dent Res. 68 (Special Issue):338

Morse DR, Esposito JV, A clarification on endodontic flare-ups. Oral Surg 70:345-8

Hashioka K, Yamasaki M, Nakane A, Horiba N, Nakamura H.  The relationship between clinical symptoms and anaerobic bacteria from infected canals.  J Endodon 18:558-61

Tjaderhane Ls, Pajari UH, Ahola RH, Backman TK, Hietala EL, Larmas MA. Leaving the pulp chamber open for drainage has no effect on the complications of root canal therapy.  Int Endodod J 28:82-85.

Sessle BJ.  Recent developments in pain research: central mechanisms of orofacial pain and its control.  J Endodon 1986;12:435-444

Gatewood RS, Himel VT, Dorn SO.  Treatment of the endodontic emergency: A decade later.  J Endodon 1990;16:284-91

Kaufman E, Heling I, Rotstein I, Friedman S, Sion A, M, Moz C, Stabholtz A.  Intraligamentary injection of slow-release methylprednisolone for the prevention of pain after endodontic treatment.  Oral Surg.  1995;77:651-4

Moos HL, Bramwell JD, Roahen JO.  A comparison of pulpectomy alone versus pulpectomy with trephination for relief of pain.  J Endodon 1996;22:422-425

Rogers MJ, Johnson BR, Remeikis NA, BeGole EA.  Comparison of effect of intracoanal use of ketorolac tromethamine and dexamethasone with oral ibuprofen on post treatment endodontic pain.  J Endodon 1999;25:381-384

Eleazer PD, Eleazer KR.  Flare-up rate in pulpally necrotic molars in one-visit versus two-visit endodontic treatment.  J Endodon  1998;24:614-61

Michaelson PL, Holland GR.  Is pulpitis painful?  Int Endod J 2002;35:829-832

Rousseau WH, Clark SJ, Newcomb BE, Walker ED, Eleazer PD, Scheetz JP.  A comparison of pain levels during pulpectomy, extractions, and restorative procedures.  J Endodon 2002;28:108-110

Liesinger A, Marshall FJ, Marshall JG.  Effect of variable doses of dexamethasone on posttreatment endodontic pain.  J Endodon 1993;19:35-9

Nusstein JM, Beck M.  Comparison of preoperative pain and medication use in emergency patients presenting with irreversible pulpitis or teeth with necrotic pulps.  Oral Surg 2003;96:207-214