International Journal of Dental Sciences and Research
ISSN (Print): 2333-1135 ISSN (Online): 2333-1259 Website: http://www.sciepub.com/journal/ijdsr Editor-in-chief: Marcos Roberto Tovani Palone
Open Access
Journal Browser
Go
International Journal of Dental Sciences and Research. 2017, 5(2), 13-21
DOI: 10.12691/ijdsr-5-2-1
Open AccessArticle

Endodontic Postoperative Pain: Etiology and Related Factors – An Update

Basil Yousif Alamassi1,

1Lecturer and specialist - Operative Dentistry, Riyadh colleges of Dentistry and Pharmacy, Riyadh Saudi Arabia

Pub. Date: March 22, 2017

Cite this paper:
Basil Yousif Alamassi. Endodontic Postoperative Pain: Etiology and Related Factors – An Update. International Journal of Dental Sciences and Research. 2017; 5(2):13-21. doi: 10.12691/ijdsr-5-2-1

Abstract

Endodontic postoperative pain is a common unexpected complication. This problem is not well understood and its incidence varies widely from one study to another. The hypothetical mechanisms for this complication include chemical, mechanical or microbial injury to the periradicular tissue. Instrumentation beyond the apical foramen and apical extrusion of the infected debris seem to be the most important causative factors by stimulation of an acute immune response in the periapical area. The reported incidence of this phenomenon varied from 1.7 to 70%. This wide range of the reported incidence is due to different study designs, pre-operative condition of the teeth, treatment procedure or technique, timing of recording pain experience, index of pain measurement and severity of pain included in the statistical analysis. Although some studies found a correlation between this phenomenon and presence of preoperative pain, presence of periapical lesion, pulpal necrosis, number of visits, technique of instrumentation, age, gender, other studies have failed to find this correlation.. No specific procedure, systemic or localized medication has been found to prevent its occurrence. Knowledge about the etiology of flare-ups and adoption of appropriate preventive measures can significantly reduce the incidence of this highly distressing and undesirable clinical phenomenon.

Keywords:
endodontic flare-ups postoperative pain etiology related factors

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]  Walton R, Fouad A. Endodontic inter-appointment flare-ups: a prospective study of incidence and related factors. J Endod. 1992; 18(4): 172-7.
 
[2]  Torabinejad M., Keltering JD, McGrav JC, Cummings RR, Dwyer TG, Tobias TS. Factors associated with endodontic interappointment emergencies of teeth with necrotic pulps. J Endod 1988; 14: 261-6.
 
[3]  Seltzer S., Naidorf JI. Flare-ups in endodontics: I. Etiological factors. J endod 1985; 11: 472-8.
 
[4]  Siquira JR. Microbial Causes of Endodontic Flare-ups. Int Endod J 2003; 36: 453-463.
 
[5]  Chavez de Paz Villanueva LE. Fusobacterium nucleatum in endodontic flare-ups.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002; 93: 179-83.
 
[6]  Gomes BPFA, Lilley JD, Drucker DB. Associations of endodontic symptoms and signs with particular combination of specific bacteria. Int Endod J 1996; 29: 69-75.
 
[7]  Siqueira JR, Rocas IN, Oliveira JCM, Santo KRN. Moleculare detection of black-pigmented bacteria in infections of endodontic origin. Int j Endod 2001; 27: 563-6.
 
[8]  Siqueira JR, Rocas IN, Souta R, Uzeda M, Colombo AP. Microbiological evaluation of acute periradicular abscesses by DNA-DNA hybridizaion. Oral surg Oral Med Oral Pathol 2001; 92: 451-7.
 
[9]  Al-Omari MA, Dummer PMH. Canal blockage and debris extrusion with eight preparation techniques. J Endod 1995; 21, 154-8.
 
[10]  Soi S, Yadav S, Sharma S, Sharma M. In Vitro Comparison of apically Extruded Debris during Root Canal Preparation of Mandibular Premolars with Manual and Rotary Instruments. J Dent Res Dent Clin Dent Prospects. 2015 9(3): 131-7.
 
[11]  Topçuoğlu HS, Düzgün S, Akpek F, Topçuoğlu G, Aktı A. Influence of a glide path on apical extrusion of debris during canal preparation using single-file systems in curved canals. Int Endod J. 2016 Jun; 49(6): 599-603.
 
[12]  Matusow RJ. Acute pulpal-alveolar cellulitis syndrom. Exacerbations during endodontic treatment: a clinical study of specific microbial isolates and their etiologic role. Part 1. Oral Surg Oral Med Oral Pathol 1986; 61: 90-5.
 
[13]  Sabeti M, simon JH, SlootsJ. Cytomegalovirus and Epstein-Barr virus are associated with symptomatic epriapical pathosis. Oral Microbiol Immunol 2003; 18: 327-8.
 
[14]  Slots J, Sabeti M, Simon J. Herpesviruses in periapical pathosis: An etiopathogenic relationship. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003; 96: 327-31.
 
[15]  El Ayouti A., Weiger R, Lost C. Frequency of Over instrumentation with an acceptable Radiographic Working Length. J Endod 2001; 27: 49-52.
 
[16]  HaumaanCHJ, Love RM. Biocompatibility of dental materials used in contemporary endodontic therapy: a review. Part 1. Intracanal drugs and substances. Int endod J 2003; 36:75-85.
 
[17]  Estrela C., Estrela CRA. Mechanism of action of Sodium Hypochlorite. Braz Dent J 2002; 13:113-117.
 
[18]  Harrison JW, Baumgartner JC, Cvec TA. Incidence of Pain associated with clinical factors during and after root canal therapy. J Endod 1983; 9: 384-7.
 
[19]  Ehrich DG, Brian JD, Walker WA. Sodium Hypochlorite accident: inadvertent injection into the maxillary sinus. J Endod 1993; 19: 180-2.
 
[20]  Hulsmann M., Han W. Complication during root canal irrigation-Literature Review and case Reports. Int endod J 2000; 33: 186-193.
 
[21]  Albashaireh ZA, Alnegrish AS. Postobturation pain after single- and multiple-visit endodontic therapy. A prospective study. J Dent 1998; 26: 227-32.
 
[22]  Aqrabawi J, Jamani K. Prevalence of post-treatment pain after cleaning and shaping of the root canal system using manual step-back versus rotary nickel titanium. Odontostomatol Trop 2006; 29: 5-9.
 
[23]  Alacam T, Tinaz AC. Interappointment emergencies in teeth with necrotic pulps. J Endod. 2002; 28: 375-7.
 
[24]  Al-Negrish AR, Habahbeh R. Flare up rate related to root canal treatment of asymptomatic pulpally necrotic central incisor teeth in patients attending a military hospital. J Dent. 2006; 34(9): 635-40.
 
[25]  Almeida G, Marques E, De Martin AS, da Silveira Bueno CE, Nowakowski A, Cunha RS. Influence of irrigating solution on postoperative pain following single-visit endodontic treatment: randomized clinical trial. J Can Dent Assoc. 2012; 78: c84.
 
[26]  Alves Vde O. Endodontic flare-ups: a prospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010 (5): 68-72.
 
[27]  Byram Ince, Ercan E, Dalli M, Dulgergil CT, Zorba YO, Colak H. Incidence of Postoperative Pain after Single- and Multi-Visit Endodontic Treatment in Teeth with Vital and Non-Vital Pulp. Eur J Dent. 2009 Oct; 3(4): 273-279.
 
[28]  Ehrmann EH, Messer HH, Adams GG. The relationship of intracanal medicaments to postoperative pain in endodontics. Int Endod J. 2003; 36: 868.
 
[29]  Eleazer PD, Eleazer KR. Flare-up rate in pulpally necrotic molars in one-visit versus two-visit endodontic treatment. J Endod. 1998; 24: 614-6.
 
[30]  El Mubarak AH, Abu-bakr NH, Ibrahim YE. Postoperative pain in multiple-visit and single-visit root canal treatment. J Endod. 2010; 36(1): 36-9.
 
[31]  Fava LRG. Acute apical periodontitis: incidence of post-operative pain using two different root canal dressings. Int Endod 1998; 31:343-7.
 
[32]  Gesi A, Hakeberg M, Warfvinge J, et al. Incidence of periapical lesions and clinical symptoms after pulpectomy—a clinical and radiographic evaluation of 1- versus 2- session treatment. Oral Surg Oral Med Oral Path Oral Radiol Endod 2006; 101: 379-88.
 
[33]  Glennon JP, Setchell DJ, Gulabivala K. Prevalence of and factors affecting post preparation pain in patients undergoing two-visit root canal treatment. Int Endod J. 2004; 37: 29.
 
[34]  Gotler M., Bar-Gil B., and Ashkenazi M.. Postoperative Pain after Root Canal Treatment: A Prospective Cohort Study. International Journal of Dentistry 2012; Volume 2012, Article ID 310467, 5 pages.
 
[35]  Henry M, Reader A, Beck M. Effect of penicillin on postoperative endodontic pain and swelling in symptomatic necrotic teeth. J Endod 2001; 27: 117-23.
 
[36]  Iqbal M, Kurtz E, Kohli M. Incidence and factors related to flare-ups in a graduate endodontic program. Int Endod J. 2009; 42(2): 99-104.
 
[37]  Oginni A, Udoye CI. Endodontic flare-ups: comparison of incidence between single and multiple visit procedures in patients attending a Nigerian teaching hospital. Odontostomatol. Trop. 2004; 27: 23-27.
 
[38]  Polycarpou N, Ng YL, Canavan D, et al. Prevalence of persistent pain after endodontic treatment and factors affecting its occurrence in cases with complete radiographic healing. Int Endod J 2005; 38: 169-78.
 
[39]  Risso PA, Cunha AJ, Araujo MC, Luiz RR. Postobturation pain and associated factors in adolescent patients undergoing one- and two-visit root canal treatment. J Dent. 2008; 36(11): 928-34.
 
[40]  Siqueira JF Jr, Rocas IN, Favieri A et al. Incidence of post-operative pain following intracanal procedures based on an antimicrobila strategy. J Endod 2002, 28, 475-60.
 
[41]  Segura-Egea JJ, Cisneros-Cabello R, Llamas-Carreras JM, Velasco-Ortega E. Pain associated with root canal treatment. Int. Endod. J. 2009; 42: 614-620.
 
[42]  Sadaf D, Ahmad MZ. Factors Associated with Postoperative Pain in Endodontic Therapy. Int. J. Biomed. Sci.2014; 10(4): 243-247.
 
[43]  Najma S, Abdul Q, Azizullah Q. A clinical study of the Post Operative Pain after Root Canal Obturation with Obtura-Ii & System-B, Warm Gutta-Percha Techniques. J. Am. Sci.2014; 10(10): 11-14.
 
[44]  Mor C, Rotstein I, Friedman S. Incidence of interappointment emergency associated with endodontic therapy. J Endod. 1992; 18(10)509-11.
 
[45]  Torabinejad M, Cymerman JJ, Frankson M, Lemon RR, Maggio JD, Schilder H. Effectiveness of various medications on postoperative pain following complete instrumentation. J endod 1994; 20: 345-54.
 
[46]  Sayed GA, Sanjyot M, Aparna P, Deepak Sl, Anurag J, and Hina G. Prevalence of and factors affecting post-obturation pain following single visit root canal treatment in Indian population: A prospective, randomized clinical trial. Contemp Clin Dent. 2012; 3(4): 459-463.
 
[47]  Udoye CI, Jafarzadeh H, Aguwa EN, Habibi M. Flare-up incidence and related factors in Nigerian adults. Contemp Dent Pract. 2011 1; 12(2): 120-3.
 
[48]  Ng YL, Glennon JP, Setchell DJ, Gulabivala K (2004). Prevalence of and factors affecting post-obturation pain in patients undergoing root canal treatment. Int. Endod. J. 37: 381-391.
 
[49]  Walton RE, Chiappinelli J. Prophylactic penicillin: effect on post treatment symptoms following root canal treatment of asymptomatic periapical pathosis. J Endod. 1993; 19: 466-70.
 
[50]  Rao KN, Kandaswamy R, Umashetty G, Rathore VP, Hotkar C, Patil BS Post-Obturation pain following one-visit and two-visit root canal treatment in necrotic anterior teeth J Int Oral Health. 2014; 6(2): 28-32.
 
[51]  Wang C, Xu P, Ren L, Dong G, Ye L. Comparison of post-obturation pain experience following one-visit and two-visit root canal treatment on teeth with vital pulps: a randomized controlled trial. Int Endod J. 2010; 43(8): 692-7.
 
[52]  Wong AW, Zhang S, Li SK, Zhu X, Zhang C, Chu CH. Incidence of post-obturation pain after single-visit versus multiple-visit non-surgical endodontic treatments. BMC Oral Health. 2015; 15: 96.
 
[53]  Bhagwat S., Mehta D. Incidence of post-operative pain following single visit endodontics in vital and non-vital teeth: An in vivo study Contemp Clin Dent. 2013 Jul-Sep; 4(3): 295-302.
 
[54]  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.
 
[55]  Jabeen S, Khurshiduzzaman M. Incidence of post obturation pain following single and multi visit root canal treatment in a teaching hospital of Bangladesh. ymensingh Med J. 2014 Apr;23(2):254-60.
 
[56]  DiRenzo A, Gresla T, Johnson BR, Rogers M, Tucker D, BeGole EA. Postoperative pain after 1- and 2-visit root canal therapy. Oral surg oral Med Oral Pathol Oral Radiol Endod 2002;93:605-10.
 
[57]  kbar I, Iqbal A, Al-Omiri MK. Flare-up rate in molars with periapical radiolucency in one-visit vs two-visit endodontic treatment. J Contemp Dent Pract. 2013;14(3):414-8.
 
[58]  Imura N, Zuolo ML. Factors associated with endodontic flare-ups: a prospective study. Int Endod J. 1995; 28:261-5.
 
[59]  Donna J, Alan S, Craig W. Retreatment versus initial root canal treatment: Factors affecting post-treatment pain. Oral Surg Oral Med Oral Patho 2001;92:321-4.
 
[60]  Mattscheck DJ, Law AS, Noblett WC. Retreatment versus initial root canal treatment: factors affecting post treatment pain. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;92(3):321-4.
 
[61]  Alí A, Olivieri JG, Duran-Sindreu F, Abella F, Roig M, García-Font M. Influence of preoperative pain intensity on postoperative pain after root canal treatment: A prospective clinical study. J Dent. 2016;45:39-42.
 
[62]  Trope M. Relationship of intracanal medicaments to endodontic flare-ups. Endod Dent Traumatol. 1990;6:226-9.
 
[63]  Georgopoulou M, Kontakiotis E, Nakou M. In vitro evaluation of the effectiveness of calcium hydroside and paramonochlorophenol on anaerobic bacteria from the root canal. Endod Dent Traumatol 1993;9:249.
 
[64]  Richard EW, Isaac FH, Robert M. Calcium Hydroxide as an Intracanal Medicaionl Effect on Posttreatment Pain. J Endod 2003;29:627.
 
[65]  Anjaneyulu K and Nivedhitha MS. Influence of calcium hydroxide on the post-treatment pain in Endodontics: A systematic review. J Cons Dentistry 2014 17(3): 200-207.
 
[66]  Menakaya IN. Oderinu OH, Adegbulugbe IC, and r Shaba OP. Incidence of postoperative pain after use of calcium hydroxide mixed with normal saline or 0.2% chlorhexidine digluconate as intracanal medicament in the treatment of apical periodontitis. Saudi Dent J. 2015; 27(4): 187-193.
 
[67]  Moskow A, Morse DR, Krasner P, Furst ML. Intracanal use of a corticosteroid solution as an endodontic anodyne. Oral Surg Oral Med Oral Pathol. 1984;58(5):600-4.
 
[68]  Negm MM. Intracanal use of a corticosteroid-antibiotic compound for the management of posttreatment endodontic pain. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;92(4):435-9.
 
[69]  Walton RE, Holton IF Jr, Michelich R. Calcium hydroxide as an intracanal medication: Effect on posttreatment pain. J Endod 2003; 29: 627-9.
 
[70]  Rimmer A. Intracanal medications and antibiotics in the control of inter appointment flare-ups. Quintessence Int. 1991; 22:997-1005
 
[71]  Singh RD, Khatter R, Bal RK, Bal CS. Intracanal medications versus placebo in reducing postoperative endodontic pain--a double-blind randomized clinical trial. Braz Dent J. 2013; 24(1): 25-9.
 
[72]  Bashetty K, Hegde J. Comparison of 2% chlorhexidine and 5.25% sodium ypochlorite irrigating solutions on postoperative pain: a randomized clinical trial. Indian J Dent Res. 2010; 21(4): 523-7.
 
[73]  MARSHALL JG. Consideration of steroids for endodontic pain. Endodontic Topics 2002, 3, 41-51.
 
[74]  Krasner P, Jackson E. Management of post treatment endodontic pain with oral dexamethasone: a double-blind study. Oral Surg Oral Med Oral Pathol1986; 62:187.
 
[75]  Eliezer K, Heling I, Rotstein I, Friedman S, Sion A, Moz C, Stabholtz A. Intra ligamentary injection of slow-release methylprednisolone for the prevention of pain after endodontic treatment. Oral Surg Oral Med Oral Pathol 1994; 77: 651-4.
 
[76]  Mehrvarzfar P1, Shababi B, Sayyad R, Fallahdoost A, Kheradpir K. Effect of supraperiosteal injection of dexamethasone on postoperative pain. Aust Endod J. 2008 Apr; 34(1): 25-9.
 
[77]  Jalalzadeh SM, Mamavi A, Shahriari S, Santos FA, Pochapski MT. Effect of pretreatment prednisolone on postendodontic pain: a double-blind parallel-randomized clinicaltrial. J Endod. 2010; 36(6): 978-81.
 
[78]  Fouad AF, Rivera EM, Walton RE, Penicillin as a supplement in resolving Localized acute apical abscess. Oral Surg Oral Med Oral Pathol 1996; 81: 590-5.
 
[79]  Pickenpaugh L, Reader A, Beck M, Meyers WJ, and Peterson LJ. Effect of Prophylactic Amoxicillin on Endodontic Flare-Up in Asymptomatic, Necrotic Teeth. J Endod. 2001; 27(1): 53-6.
 
[80]  Morse DR, Furst ML, Lefkowitz RD, D’angelo D, Esposito JV. A comparison of erythromycin and cefadroxil in the prevention of flare-ups from asymptomatic teeth with pulpal necrosis and associated periapical pathosis. Oral Surg Oral Med Oral Pathol 1990; 69: 619-30.
 
[81]  Abbott AA, Koren LZ, Morse DR, Sinai IH, Doo RS, Furst ML. A prospective randomized trial on effecacy of antibiotic prophylaxix in asymptomatic teeth with pulpal necrosis and associated periapical pathosis. Oral Surg Oral Med Oral Pathol 1988; 66: 722-33.
 
[82]  Alsomadi L, Al Habahbeh R. Role of Prophylactic Antibiotics in the Management of Postoperative Endodontic Pain. J Contemp Dent Pract. 2015; 16(12): 939-43.
 
[83]  Menhinick KA, Gutmann JL, Regan JD, Taylor SE, Buschange PH. The efficacy of pain control following nonsurgical root canal treatment using ibuprofen or a combination of ibuprofen and acetaminophen in a randomized, double-blind, placebo-controlled study. Int endod J 2004; 37: 531-541.
 
[84]  Menke ER, Jackson CR, Bagby MD, Tracy TS. The Effectiveness of Prophylactic Etodolac on Postendodontic Pain. J Endod. 2000; 26: 712-715.
 
[85]  Gopikrishan V, Parameswaran A. Effectiveness of Prophylactic Use of Rofecoxib in Comparison with Ibuprofen on Postendodontic Pain. J Endod 2003; 29: 62-4.
 
[86]  Nekoofar MH, Sadeghipanah M, Dehpour AR. Evaluation of meloxicam (A cox-2 inhibitor) for management of postoperative endodontic pain: a double-blind placebo-controlled study. Endod. 2003; 29(10): 634-7.
 
[87]  Attar S, Bowles WR, Baisden MK, Hodges JS, McClanahan SB. Evaluation of pretreatment analgesia and endodontic treatment for postoperative endodontic pain. J Endod. 2008; 34(6): 652-5.
 
[88]  Negm MM. Management of endodontic pain with nonsteroidal anti-inflammatory agents: a double-blind, placebo-controlled study. Oral Surg Oral Med Oral Pathol 1989; 67: 88-95.
 
[89]  Metri M, Hegde S, Bhandi S. Effect of pretreatment diclofenac sodium on postendodontic pain: A randomised controlled trial. J Conserv Dent. 2016 Jan-Feb; 19(1): 7-10.
 
[90]  Mokhtari F, Yazdi K, Mahabadi AM, Modaresi SJ, Hamzeheil Z. Effect of re-medication with Indomethacin and Ibuprofen on Postoperative Endodontic Pain: A Clinical Trial. Iran Endod J. 2016; 11(1): 57-62.
 
[91]  Borges ÁH, Pereira TM, Porto AN, de Araújo Estrela CR, Miranda Pedro FL, Aranha AM, Guedes OA. The Influence of Cervical Pre-flaring on the Amount of Apically Extruded Debris after Root Canal Preparation Using Different Instrumentation Systems. Endod. 2016; 42(3): 465-9.
 
[92]  Wei X, Tin Z, Peng S. The effect of root canal preparation with nickel-titanium rotary instruments in reduction of post-operative pain. J of Stomatology. 2003; 21: 202-4.
 
[93]  Arias A, de la Macorra JC, Azabal M , Hidalgo JJ , Peters OA Prospective case controlled clinical study of post-endodontic pain after rotary root canal preparation performed by a single operator. J of Dentistry 2015; 43(3): 389-395.
 
[94]  Arias A, Azabal M, Hidalgo JJ, de la Macorra JC. Relationship between post endodontic pain, tooth diagnostic factors, and apical patency. Endod. 2009; 35(2): 189-92.
 
[95]  Kara TA, Gerek M. Effect of Working Length Measurement by Electronic Apex Locator or Digital Radiography on Postoperative Pain: A Randomized Clinical Trial.  Journal of endodontics.2014; 40(1):38-41.