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Differential diagnoses for persistent pain after root canal treatment: a study in the National Dental Practice-based Research Network.

Abstract：

INTRODUCTION:Pain present 6 months after root canal treatment (RCT) may be of odontogenic or nonodontogenic origin. This is important because treatments and prognoses are different; therefore, the aim of this study was to provide specific diagnoses of patients reporting pain 6 months after receiving initial orthograde RCT. METHODS:We enrolled patients from the Midwest region of an existing prospective observational study of pain after RCT. Pain at 6 months was defined as ≥1 day of pain and average pain intensity of at least 1 of 10 over the preceding month. An endodontist and an orofacial pain practitioner independently performed clinical evaluations, which included periapical and cone-beam computed tomographic radiographs, to determine diagnoses. RESULTS:Thirty-eight of the 354 eligible patients in the geographic area (11%) met the pain criteria, with 19 (50%) consenting to be clinically evaluated. As the sole reason for pain, 7 patients (37%) were given odontogenic diagnoses (4 involving the RCT tooth and 3 involving an adjacent tooth). Eight patients (42%) were given nonodontogenic pain diagnoses (7 from referred temporomandibular disorder pain and 1 from persistent dentoalveolar pain disorder). Two patients (11%) had both odontogenic and nonodontogenic diagnoses, whereas 2 (11%) no longer fit the pain criteria at the time of the clinical evaluation. CONCLUSIONS:Patients reporting "tooth" pain 6 months after RCT had a nonodontogenic pain diagnosis accounting for some of this pain, with temporomandibular disorder being the most frequent nonodontogenic diagnosis. Dentists should have the necessary knowledge to differentiate between these diagnoses to adequately manage their patients.

journal_name

J Endod

journal_title

Journal of endodontics

authors

Nixdorf DR,Law AS,John MT,Sobieh RM,Kohli R,Nguyen RH,National Dental PBRN Collaborative Group.

doi

10.1016/j.joen.2014.12.012

subject

Has Abstract

pub_date

2015-04-01 00:00:00

pages

457-63

issue

eissn

0099-2399

issn

1878-3554

pii

S0099-2399(14)01222-9

journal_volume

pub_type

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Differential diagnoses for persistent pain after root canal treatment: a study in the National Dental Practice-based Research Network.