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Painful root filled teeth: prevalence, characteristics, impact, possible origins and interventions
Malmö University, Faculty of Odontology (OD). The Public Dental Service in Region Örebro County.ORCID iD: 0000-0003-4020-7850
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

It is common knowledge for all dental personnel that root filled teeth can be painful. Earlier studies on this subject are meta-analyses and clinical studies reporting data in relation to the time since treatment was performed, not epidemiological studies reporting on the general population or cohorts who regularly attend dentistry. The studies often report ´all-cause tooth pain´ or´odontogenic´ versus ´non-odontogenic´ tooth pain. These are broad categories with different possibilities for the origins of pain. A better understanding of the possible origins of pain would aid in clinical assessment.

This doctoral thesis is centred around a cross-sectional clinical data collection in general dental practice and follow up of interventions monitored by collecting data from dental records over six years. The aim is to better understand painful root filled teeth better by exploring anamnestic, clinical, and radiographic characteristics at a regular check-up by the regular dentist.

Study I is an observational cross-sectional study. The aim was to investigate the frequency and characteristics of pain and discomfort, irrespective of origin, in a cohort of adult patients regularly attending the Public Dental Service in Sweden. A further aim was to examine whether there was an association between pain symptoms, clinical status and radiological findings. One out of ten participants experienced pain or discomfort from their root filled teeth; the average pain intensity was low. Lower age, tenderness to percussion and apical palpation were associated with painful teeth. Furthermore, 41.9% of the painful teeth had apical radiolucency.

Study II is a case-control study. Cases were participants with at least one painful root filled tooth, and controls were participants with a root filled tooth without pain. The aim was to compare, in detail, painful root filled teeth with root filledteeth without pain matched on age, sex, jaw- and tooth type, with the additional aim to explore patient- and tooth related factors that may explain the pain. It was more common with tenderness to percussion and apical palpation, as well as swelling, pocket depths greater than 6mm and apical radiolucency for the painful teeth. For 60% of the painful teeth, apical periodontitis was the likely origin of pain, marginal periodontitis and TMD were found to contribute in 30%, and for 10%, no obvious clinical or radiological findings could explain the pain.

In Study III, the painful teeth were subdivided into two groups: those with at least one sign of disease and those with no such signs. The aim was to compare painful root filled teeth with and without signs of inflammatory disease, regarding (i) pain characteristics, (ii) impact of pain and (iii) patient characteristics. No differences could be found except for higher pain intensity and no apical palpation of the teeth without signs of disease. The impact of pain was equally low, and there were no differences in patient characteristics.

In Study IV, all the participants from Study I who could be followed for six years were included, and the interventions were followed by collecting data from the dental records. The aim was to explore longitudinally what happens to root filled teeth in terms of interventions, regardless of time since RCT, during six years. A further aim was to explore how the interventions were associated with variables obtained from a standard clinical examination. Regarding the painful teeth, a third were extracted, another third had 'no event' recorded and, in falling order, the rest were 'scheduled for follow-up', had a 'new restoration' or were 'endodontically re- treated'. In comparison, it was more common with extraction and RCT for painful teeth than 'no event', 'scheduled for follow-up' and new restoration.

In conclusion, the findings indicate that pain from root filled teeth is a relatively common problem. Those with pain generally have a low intensity and minimal impact on everyday life. Apical periodontitis is the most common origin of pain, but a few are difficult to diagnose with the common examination modalities. The clinical presentation of teeth with and without signs of inflammation resemble each other, pointing to possible help from other diagnostic modalities. Even though extraction and RCT are more common interventions for painful teeth, not all painful teeth receive an intervention.

Place, publisher, year, edition, pages
Malmö: Malmö University Press, 2024. , p. 85
Series
Malmö University Odontological Dissertations, ISSN 1650-6065, E-ISSN 2004-9307
National Category
Dentistry
Identifiers
URN: urn:nbn:se:mau:diva-72414DOI: 10.24834/isbn.9789178775255ISBN: 978-91-7877-524-8 (print)ISBN: 978-91-7877-525-5 (electronic)OAI: oai:DiVA.org:mau-72414DiVA, id: diva2:1916049
Public defence
2024-12-20, Odontologiska fakulteten, aulan (KL:2370), Smedjegatan 16, Malmö, 09:15 (Swedish)
Opponent
Supervisors
Note

Paper II in dissertation as manuscript. 

Paper II not included in the fulltext online.

Available from: 2024-11-26 Created: 2024-11-26 Last updated: 2024-11-29Bibliographically approved
List of papers
1. The frequency and characteristics of pain and discomfort associated with root filled teeth: A practice based study.
Open this publication in new window or tab >>The frequency and characteristics of pain and discomfort associated with root filled teeth: A practice based study.
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2019 (English)In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 52, no 9, p. 1264-1273Article in journal (Refereed) Published
Abstract [en]

AIM: To (1) investigate the frequency and characteristics of pain and discomfort associated with root filled teeth in adult patients regularly attending the Public Dental Service in Örebro County, Sweden; (2) assess the association between symptoms and clinical and radiographic findings, and (3) explore the impact of pain and discomfort from root filled teeth on daily life. METHODOLOGY: Patient records of adult patients (> 20 years) scheduled for routine check-ups in April 2015 were screened to identify individuals with root filled teeth; all patients with >1 root filled tooth were asked to participate. The examination comprised clinical and radiographic examinations and questionnaires on general health, on pain symptoms from root filled teeth, and on the impact of pain on daily activities. In a general estimation equation (GEE), examination findings and patient-related factors were independently analysed in relation to the outcome "presence of pain". RESULTS: In total 550 patients with 1 256 root filled teeth participated. Fifty-three patients (9.6%) experienced pain or discomfort from 62 (4.9%) root filled teeth. Lower age, percussion tenderness and apical tenderness were significantly associated with pain (P > 0.001-P=0.044). The average pain intensity was 2.1 on (0-10) Numeric Rating Scale, and average duration was 28.4 months. The impact on daily life was low. CONCLUSIONS: On average, pain associated with root filled teeth was of mild intensity, >2 years of duration and had low impact on daily life. Although the significantly associated clinical findings may indicate apical periodontitis as the most probable explanation in some teeth, the origin of pain from root filled teeth remains partly unexplained.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
discomfort, pain, prevalence, radiolucency, root filled teeth
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-6860 (URN)10.1111/iej.13124 (DOI)000480631900003 ()30980723 (PubMedID)2-s2.0-85066128005 (Scopus ID)28585 (Local ID)28585 (Archive number)28585 (OAI)
Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-11-26Bibliographically approved
2. Root-filled teeth with and without pain in a cohort of individuals scheduled for regulardental check-ups: A matched case-control study
Open this publication in new window or tab >>Root-filled teeth with and without pain in a cohort of individuals scheduled for regulardental check-ups: A matched case-control study
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(English)Manuscript (preprint) (Other academic)
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-72413 (URN)
Available from: 2024-11-29 Created: 2024-11-26 Last updated: 2024-11-26Bibliographically approved
3. Characteristics and impact of pain from root-filled teeth: A practice-based cross-sectional study comparing painful teeth with and without signs of inflammatory dental disease
Open this publication in new window or tab >>Characteristics and impact of pain from root-filled teeth: A practice-based cross-sectional study comparing painful teeth with and without signs of inflammatory dental disease
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2024 (English)In: The Journal of Oral & Facial Pain and Headache, ISSN 2333-0384 , E-ISSN 2333-0376 , Vol. 38, no 1, p. 64-76Article in journal (Refereed) Published
Abstract [en]

To compare pain characteristics, impact of pain and characteristics of patients withpainful root-filled teeth with and without signs of inflammatory dental disease. Thiscross-sectional study was performed in the Public Dental Health services, RegionÖrebro County, Sweden. Adult patients with ≥1 root-filled tooth identified at theirregular check-up were included and assigned to one of two groups; those with ≥1sign of inflammatory dental disease (DD+) and those without any such sign (DD−).Patients/teeth were compared regarding pain characteristics (intensity, frequency,duration, quality and provoking factors), impact of pain (medication intake, impacton life) and patient characteristics as background factors (general health, other bodilyand orofacial pain). Statistics included descriptive data (frequency tables) and groupcomparisons (Chi-square, Fisher’s Exact and Mann-Whitney U-tests). The DD+ groupincluded 27 participants (30 teeth) and the DD− group 22 participants (23 teeth).On average, pain intensity was mild, the frequency most often recurrent, and theimpact was low. Average pain duration since onset exceeded 2 years in both groups.The only observed between-group differences were average pain intensity; 3.1 (0–10Numerical Rating Scale (NRS)) in DD− group compared to 1.6 for DD+ (p = 0.030),and tenderness to apical palpation; only reported in the DD+ group. The similaritiesin clinical presentation between the two groups underscore the difficulties in correctlydistinguishing between pain of odontogenic and non-odontogenic origin in root-filledteeth with a standard clinical investigation. Additional diagnostic methods need to beinvestigated for their ability to differentiate between tooth pain or discomfort of differentorigins

Place, publisher, year, edition, pages
MRE press, 2024
Keywords
Dentistry/diagnosis, Dentistry/epidemiology, Endodontics, Facial pain, Pain, Root canal therapy
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-67133 (URN)10.22514/jofph.2024.007 (DOI)001201730900002 ()2-s2.0-85205265377 (Scopus ID)
Available from: 2024-05-07 Created: 2024-05-07 Last updated: 2024-11-26Bibliographically approved
4. Interventions in root‐filled teeth identified in general dental practice: A 6‐year longitudinal observational study
Open this publication in new window or tab >>Interventions in root‐filled teeth identified in general dental practice: A 6‐year longitudinal observational study
Show others...
2024 (English)In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 57, no 9, p. 1212-1227Article in journal (Refereed) Published
Abstract [en]

Aim: To investigate what happens to cross-sectionally identified root-filled teeth over a 6-year period, regardless of the time that elapsed since primary root canal treatment, in a cohort of adult patients regularly attending a Public Dental Service. A secondary aim was to investigate how the cumulative events affecting root-filled teeth over the same time were associated with variables obtained from a baseline examination.

Methodology: Adult patients with ≥1 previously root-filled tooth and regularly attending the Public Dental Service in Örebro County were enrolled for study participation in 2015. General dental practitioners examined all identified root-filled teeth in this cohort at baseline using a standardized protocol and were also responsible for further decision-making and treatments. After six years, information on events of the root-filled teeth was collected from dental records. The highest rating (most invasive treatment) on a 5-point ordinal scale was used in the analyses. Regression analyses with stepwise selection were performed for associations between patient- and tooth-related factors and events.

Results: A total of 445 patients with 1007 root-filled teeth were followed the entire observation time. Twenty (2.0%) of the root-filled teeth had endodontic retreatment and 150 (14.9%) were extracted over six years. Among teeth with periapical radiolucency or pain, the majority did not undergo retreatment or extraction; however, the multivariate analysis demonstrated that retreatment or extraction was associated with baseline recordings of teeth with periapical radiolucency (p < .0001), tenderness to percussion (p < .0001), and poor coronal restoration (p < .0001).

Conclusions: This study corroborates the notion that in general dentistry, root-filled teeth with radiological signs of apical disease often remain untreated over time. Furthermore, it also reveals that root-filled teeth presenting with mild pain do not necessarily receive any intervention. However, teeth with baseline signs of apical periodontitis, pain, or inadequate coronal restoration were more likely to have received intervention during the six-year period.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
endodontically treated teeth, endodontics, periapical diseases, public health, retreatment, root canal therapy
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-67250 (URN)10.1111/iej.14079 (DOI)001216357900001 ()39302850 (PubMedID)2-s2.0-85192544982 (Scopus ID)
Available from: 2024-05-16 Created: 2024-05-16 Last updated: 2024-11-26Bibliographically approved

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Jonsson Sjögren, Jakob

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