The incidence of pain associated with endodontic treatment is estimated to be anything between 3% and 69% of patients.[i] Regardless of the numbers, it is essential that professionals minimise the discomfort that patients feel. There are several things we can do to reduce this risk and ensure that patients have as positive a treatment experience as possible.
Managing the after effects
Appropriate analgesia before or during endodontic treatment has been shown to reduce postoperative pain, making the patient more comfortable during the recovery phase. Depending on the situation, you might select preoperative non-steroidal, anti-inflammatory drugs (NSAIDs), which have been shown to block pain signals. An alternative is local anaesthetic administrated during treatment to lower the impact of postoperative pain after non-surgical therapy.[ii] If we can decrease the severity of pain that a patient feels following endodontic treatment in this way, this will have a significant on their overall experience.
Optimising clinical techniques
From a clinical perspective, there are various techniques that can be considered during endodontic treatment. These should be evaluated during the planning phase and are crucial for optimising the predictability and quality of the treatment outcome. The goal is always to avoid or minimise potential complications and therefore ensure no unnecessary pain is caused. An example might be using radiographic images to accurately measure the anatomy and prevent excessive instrumentation or extrusion of root canal debris past the apical foramen, which can cause iatrogenic periapical discomfort.[iii] It is also important to ensure no mechanical or chemical damage to the tissues, which requires management of the inflammatory response as well.
Products matter too
Evidence-based clinical techniques can only be implemented with high-quality products and technologies. For example, research shows that rotary endodontic systems are associated with lower postoperative endodontic pain[iv] and shorter treatment times[v] than manual instrumentation.
Other relevant technologies include CT and/or CBCT imaging units, 3D printers and digital impression scanners. Several are integrated with software assisted by artificial intelligence (AI), which streamlines the professional workflow and likely frees up some more time to spend interacting with the patient. Modern technologies are designed to maximise the accuracy and predictability of diagnostics and treatment planning, as well as improve the delivery of treatment or retreatment, and restoration. They help to reduce the risk of complications and alleviate unnecessary postoperative pain. It is worth noting that these technologies are not quite perfect with some refinement still needed in some areas. That said, some very promising inroads are being made.
Patient-centred endodontics
Awareness of the clinical challenges faced in endodontics must be accompanied by knowledge, skills, products and technologies to prevent them. A truly patient-centred approach to endodontics means optimising both the clinical outcome and the patient experience – reducing postoperative pain is just one part of this, but it is an important one.
Author: Dr Alyn Morgan, President of the BES.
[i] AlRahabi MK. Predictors, prevention, and management of postoperative pain associated with nonsurgical root canal treatment: A systematic review. J Taibah Univ Med Sci. 2017 May 9;12(5):376-384. doi: 10.1016/j.jtumed.2017.03.004. PMID: 31435267; PMCID: PMC6695063.
[ii] AlRahabi MK. Predictors, prevention, and management of postoperative pain associated with nonsurgical root canal treatment: A systematic review. J Taibah Univ Med Sci. 2017 May 9;12(5):376-384. doi: 10.1016/j.jtumed.2017.03.004. PMID: 31435267; PMCID: PMC6695063.
[iii] Law A.S., Nixdorf D.R., Aguirre A.M., Reams G.J., Tortomasi A.J., Manne B.D., Harris D. Predicting severe pain after root canal therapy in the National Dental PBRN. J. Dent. Res. 2015;94:37–43. doi: 10.1177/0022034514555144
[iv] da Silveira MT, Batista SM, Mamede Veloso SR, de Oliveira NG, de Vasconcelos Carvalho M, de Melo Monteiro GQ. Effect of Reciprocating and Rotary Systems on Postoperative Pain: A Systematic Review and Meta-Analysis. Iran Endod J. 2021;16(1):1-16. doi: 10.22037/iej.v16i1.27944. PMID: 36704409; PMCID: PMC9709880.
[v] Manchanda, S, Sardana, D, Yiu, CKY. A systematic review and meta-analysis of randomized clinical trials comparing rotary canal instrumentation techniques with manual instrumentation techniques in primary teeth. International Endodontic Journal, 53, 333–353, 2020.