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.

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

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.