INTRODUCTION: Little is known about ill-defined pain that persists after
endodontic procedures, including an estimate of the problem's magnitude. We
conducted a systematic review of prospective studies that reported the frequency
of nonodontogenic pain in patients who had undergone endodontic procedures.
METHODS: Nonodontogenic pain was defined as dentoalveolar pain present for 6
months or more after endodontic treatment without evidence of dental pathology.
Endodontic procedures reviewed were nonsurgical root canal treatment,
retreatment, and surgical root canal treatment. Studies were searched in four
databases electronically, complemented by hand searching. A summary estimate of
nonodontogenic tooth pain frequency was derived using random-effects
meta-analysis. RESULTS: Of 770 articles retrieved and reviewed, 10 met inclusion
criteria, and nine had data on both odontogenic and nonodontogenic causes of
pain. A total of 3,343 teeth were enrolled within the included studies and 1,125
had follow-up information regarding pain status. We identified 48 teeth with
nonodontogenic pain and estimated a 3.4% (95% confidence interval, 1.4%-5.5%)
frequency of occurrence. In nine articles containing data regarding both
odontogenic and nonodontogenic causes of tooth pain, 56% (44/78) of all cases
were thought to have a nonodontogenic cause. CONCLUSIONS: Nonodontogenic pain is
not an uncommon outcome after root canal therapy and may represent half of all
cases of persistent tooth pain. These findings have implications for the
diagnosis and treatment of painful teeth that were previously root canal treated
because therapy directed at the tooth in question would not be expected to
resolve nonodontogenic pain.
Supported by National Institutes of Health grants: K12-RR023247, U01-DE016746 and U01-DE016747 (DR Nixdorf).
Nixdorf, DR; Moana-Filho, EJ; Law, AS; McGuire, LA; Hodges, JS; John, MT.
Frequency of Nonodontogenic Pain after Endodontic Therapy: A Systematic Review and Meta-Analysis.
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