Abstract
The most common cause of pulp/periapical pathosis is caries. In this chapter host–microbial interaction and the pulp’s dynamic response to the inflammatory process is described. The process occurs within a unique low-compliance environment due to the hard unyielding walls of dentin surrounding the pulp. The result of this anatomy is an inability of the pulp to swell as it becomes progressively more inflamed. Understanding canal anatomy is an essential part of recognizing endodontic symptoms and providing emergency pain relief and subsequent therapy.
Recognizing factors that predispose a patient to pain is an important part of implementing pain-preventive strategies. While iatrogenic errors (inaccurate measurement control, over-instrumentation) often play a role in postoperative pain, there are other, less obvious, factors including genetics, gender, and anxiety that may predispose a patient to pain. The significance of these factors in relation to patient’s pain is described. Strategies to reduce patient’s anxiety are also discussed.
Postoperative pain may occur following instrumentation or obturation. Pain-preventive, evidence-based strategies, including occlusal reduction, are described.
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References
Editors of the American Heritage Dictionary (2007) The American Heritage Medical Dictionary. Houghton Mifflin Company, Boston
Andreasen JO (2011) Traumatic dental injuries: a manual. Wiley-Blackwell, West Sussex
Angst MS, Phillips NG, Drover DR et al (2012) Pain sensitivity and opioid analgesia: a pharmacogenomic twin study. Pain 153(7):1397–1409
Arias A, De La Macorra JC, Hidalgo JJ et al (2013) Predictive models of pain following root canal treatment: a prospective clinical study. Int Endod J 46(8):784–793
Barnett F, Tronstad L (1989) The incidence of flare-ups following endodontic treatment. J Dent Res 68:1253
Binkley CJ, Beacham A, Neace W et al (2009) Genetic variations associated with red hair color and fear of dental pain, anxiety regarding dental care and avoidance of dental care. J Am Dent Assoc 140(7):896–905
Carr DB, Goudas LC (1999) Acute pain. Lancet 353(9169):2051–2058
Carter LE, McNeil DW, Vowles KE et al (2002) Effects of emotion on pain reports, tolerance and physiology. Pain Res Manag 7(1):21–30
Carvalho RM, Manso AP, Geraldeli S et al (2012) Durability of bonds and clinical success of adhesive restorations. Dent Mater 28(1):72–86
Clem WH (1970) Posttreatment endodontic pain. J Am Dent Assoc 81(5):1166–1170
De Sa AR, Moreira PR, Xavier GM et al (2007) Association of CD14, IL1B, IL6, IL10 and TNFA functional gene polymorphisms with symptomatic dental abscesses. Int Endod J 40(7):563–572
Droll B, Drum M, Nusstein J et al (2012) Anesthetic efficacy of the inferior alveolar nerve block in red-haired women. J Endod 38(12):1564–1569
Eli I, Schwartz-Arad D, Baht R et al (2003) Effect of anxiety on the experience of pain in implant insertion. Clin Oral Implants Res 14(1):115–118
Eli I, Schwartz-Arad D, Bartal Y (2008) Anxiety and ability to recognize clinical information in dentistry. J Dent Res 87(1):65–68
Fillingim RB, King CD, Ribeiro-Dasilva MC et al (2009) Sex, gender, and pain: a review of recent clinical and experimental findings. J Pain 10(5):447–485
Gedney JJ, Logan H, Baron RS (2003) Predictors of short-term and long-term memory of sensory and affective dimensions of pain. J Pain 4(2):47–55
Georgopoulou M, Anastassiadis P, Sykaras S (1986) Pain after chemomechanical preparation. Int Endod J 19(6):309–314
Gesi A, Hakeberg M, Warfvinge J et al (2006) 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 Pathol Oral Radiol Endod 101(3):379–388
Greenspan JD, Craft RM, Leresche L et al (2007) Studying sex and gender differences in pain and analgesia: a consensus report. Pain 132(Suppl 1):S26–S45
Hargreaves KM, Cohen S, Berman LH (2011) Cohen’s pathways of the pulp. Mosby Elsevier, St. Louis
Harrison JW, Baumgartner JC, Svec TA (1983) Incidence of pain associated with clinical factors during and after root canal therapy. Part 2. Postobturation pain. J Endod 9(10):434–438
Kakehashi S, Stanley HR, Fitzgerald RJ (1965) The effects of surgical exposures of dental pulps in germ-free and conventional laboratory rats. Oral Surg Oral Med Oral Pathol 20:340–349
Kim S (1985) Microcirculation of the dental pulp in health and disease. J Endod 11(11):465–471
Klages U, Kianifard S, Ulusoy O et al (2006) Anxiety sensitivity as predictor of pain in patients undergoing restorative dental procedures. Community Dent Oral Epidemiol 34(2):139–145
Lahmann C, Schoen R, Henningsen P et al (2008) Brief relaxation versus music distraction in the treatment of dental anxiety: a randomized controlled clinical trial. J Am Dent Assoc 139(3):317–324
Liem EB, Lin CM, Suleman MI et al (2004) Anesthetic requirement is increased in redheads. Anesthesiology 101(2):279–283
Lindemann M, Reader A, Nusstein J et al (2008) Effect of sublingual triazolam on the success of inferior alveolar nerve block in patients with irreversible pulpitis. J Endod 34(10):1167–1170
Little JW, Falace DA, Miller C et al (2012) Dental management of the medically compromised patient. Mosby, St. Louis
Martin FE (2003) Carious pulpitis: microbiological and histopathological considerations. Aust Endod J 29(3):134–137
Menezes-Silva R, Khaliq S, Deeley K et al (2012) Genetic susceptibility to periapical disease: conditional contribution of MMP2 and MMP3 genes to the development of periapical lesions and healing response. J Endod 38(5):604–607
Mjor IA (2009) Dentin permeability: the basis for understanding pulp reactions and adhesive technology. Braz Dent J 20(1):3–16
Morsani JM, Aminoshariae A, Han YW et al (2011) Genetic predisposition to persistent apical periodontitis. J Endod 37(4):455–459
Muralidharan A, Smith MT (2011) Pain, analgesia and genetics. J Pharm Pharmacol 63(11):1387–1400
Nakai Y, Milgrom P, Mancl L et al (2000) Effectiveness of local anesthesia in pediatric dental practice. J Am Dent Assoc 131(12):1699–1705
Ng SK, Chau AW, Leung WK (2004) The effect of pre-operative information in relieving anxiety in oral surgery patients. Community Dent Oral Epidemiol 32(3):227–235
Nusstein JM, Reader A, Drum M (2010) Local anesthesia strategies for the patient with a “hot” tooth. Dent Clin North Am 54(2):237–247
O’keefe EM (1976) Pain in endodontic therapy: preliminary study. J Endod 2(10):315–319
Payen JF, Bru O, Bosson JL et al (2001) Assessing pain in critically ill sedated patients by using a behavioral pain scale. Crit Care Med 29(12):2258–2263
Pizzo PA, Clark NM (2012) Alleviating suffering 101–pain relief in the United States. N Engl J Med 366(3):197–199
Polycarpou N, Ng YL, Canavan D et al (2005) Prevalence of persistent pain after endodontic treatment and factors affecting its occurrence in cases with complete radiographic healing. Int Endod J 38(3):169–178
Roberts HW, Pashley DH (2012) Hydrostatic pulpal pressure effect upon microleakage. Am J Dent 25(1):49–53
Rosenberg PA, Babick PJ, Schertzer L et al (1998) The effect of occlusal reduction on pain after endodontic instrumentation. J Endod 24(7):492–496
Saxen MA, Newton CW (1999) Managing the endodontic patient with disabling anxiety or phobia. J Indiana Dent Assoc 78(4):21–23
Torabinejad M, Dorn SO, Eleazer PD et al (1994) Effectiveness of various medications on postoperative pain following root canal obturation. J Endod 20(9):427–431
Torabinejad M, Kettering JD, McGraw JC et al (1988) Factors associated with endodontic interappointment emergencies of teeth with necrotic pulps. J Endod 14(5):261–266
Trope M (1990) Relationship of intracanal medicaments to endodontic flare-ups. Endod Dent Traumatol 6(5):226–229
Trope M (1991) Flare-up rate of single-visit endodontics. Int Endod J 24(1):24–26
Van Hassel HJ (1971) Physiology of the human dental pulp. Oral Surg Oral Med Oral Pathol 32(1):126–134
Vuilleumier PH, Stamer UM, Landau R (2012) Pharmacogenomic considerations in opioid analgesia. Pharmgenomics Pers Med 5:73–87
Walton R (2002) Interappointment flare-ups: incidence, related factors, prevention, and management. Endod Top 3:67–76
Yesilsoy C, Koren LZ, Morse DR et al (1988) Post-endodontic obturation pain: a comparative evaluation. Quintessence Int 19(6):431–438
Young J, Siffleet J, Nikoletti S et al (2006) Use of a behavioural pain scale to assess pain in ventilated, unconscious and/or sedated patients. Intensive Crit Care Nurs 22(1):32–39
Yu SM, Bellamy HA, Kogan MD et al (2002) Factors that influence receipt of recommended preventive pediatric health and dental care. Pediatrics 110(6):e73
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Rosenberg, P.A. (2014). Causes of Endodontic Pain and Preventive Strategies. In: Endodontic Pain. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54701-0_5
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DOI: https://doi.org/10.1007/978-3-642-54701-0_5
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