Department of Endodontics, University of Texas Health at San Antonio, San Antonio, Texas.
Department of Endodontics, University of Texas Health at San Antonio, San Antonio, Texas.
J Endod. 2020 Dec;46(12):1841-1848. doi: 10.1016/j.joen.2020.09.006. Epub 2020 Sep 15.
Patients seeking endodontic treatment commonly present with reduced mechanical pain thresholds (ie, mechanical allodynia [MA]) in the offending teeth. In patients with moderate to severe pain, MA may manifest in the teeth contralateral to the offending teeth because of the onset of central sensitization (CS). We hypothesize that there are quantitative differences in MA and CS in patients with different pulp and periradicular diagnoses.
Patients (n = 70) receiving endodontic treatment in the graduate endodontic clinic at the University of Texas Health Science Center at San Antonio and healthy volunteers (n = 10) were included in this cross-sectional study. The mechanical pain threshold from molar teeth was measured by a digital bite force transducer on the offending tooth (ipsilateral) and the contralateral tooth. Ipsi- and contralateral MA among different endodontic diagnoses were analyzed using the Kruskal-Wallis with Dunn post hoc test and the Student t test for differences between sexes. Multivariate regression models analyzed predictors for MA and CS.
Periradicular diagnoses of asymptomatic apical periodontitis, symptomatic apical periodontitis, and chronic apical abscess cases were significantly associated with MA. CS, seen as contralateral MA, was only detected in pulpal diagnosis of symptomatic irreversible pulpitis, previously initiated treatment, symptomatic apical periodontitis, and chronic apical abscess. Females experienced significantly lower pain thresholds than males on both sides. MA and CS were significantly correlated in both sexes. The preoperative pain level and duration were significant predictors for MA and CS only in female patients. Lastly, age was a significant predictor for MA in females.
The magnitude of MA and CS varied with different endodontic diagnoses, with CS being correlated with increases in MA. Only in female patients were age, preoperative pain duration, and intensity significant predictors for the development of MA and CS.
寻求牙髓治疗的患者常表现出受累牙机械痛觉阈值降低（即机械性痛觉过敏[MA]）。在中重度疼痛患者中，由于中枢敏化（CS）的发生，受累牙对侧的牙齿可能会出现 MA。我们假设不同牙髓和根尖周诊断患者的 MA 和 CS 存在定量差异。
本横断面研究纳入了在德克萨斯大学健康科学中心圣安东尼奥分校研究生牙髓诊所接受牙髓治疗的患者（n=70）和健康志愿者（n=10）。通过数字咬合力传感器测量磨牙的机械疼痛阈值，测量对象为受累牙（同侧）和对侧牙。采用 Kruskal-Wallis 检验和 Dunn 事后检验分析不同牙髓诊断的同侧和对侧 MA，采用 Student t 检验分析性别间差异。多变量回归模型分析 MA 和 CS 的预测因素。
无症状根尖周炎、有症状根尖周炎和慢性根尖脓肿的根尖周诊断与 MA 显著相关。CS 表现为对侧 MA，仅在有症状不可复性牙髓炎、已开始治疗、有症状根尖周炎和慢性根尖脓肿的牙髓诊断中检测到。女性在两侧的疼痛阈值均显著低于男性。MA 和 CS 在两性中均显著相关。术前疼痛水平和持续时间仅在女性患者中是 MA 和 CS 的显著预测因素。最后，年龄是女性 MA 的显著预测因素。
MA 和 CS 的幅度因不同的牙髓诊断而异，CS 与 MA 的增加相关。仅在女性患者中，年龄、术前疼痛持续时间和强度是 MA 和 CS 发生的显著预测因素。
