de Oliveira Damasceno Claudjane, da Silveira Bueno Carlos Eduardo, De Martin Alexandre Sigrist, Pelegrine Rina Andréa, Villela Alexandre Mascarenhas, Ruivo Liliana Machado, Shoji Kato Augusto
Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Endodontia, Campinas, SP, Brazil.
Department of Restorative Dentistry, Endodontics, and Dental Materials, Discipline of Endodontics, School of Dentistry of Bauru, University of São Paulo, Bauru, SP, Brazil.
Iran Endod J. 2020 Fall;15(4):221-226. doi: 10.22037/iej.v15i4.26214.
The aim of this study was to evaluate the possible associations between pre-established clinical variables and manifestation of postoperative pain after endodontic treatments performed by graduate students in endodontics, from June 2016 to December 2017.
A total of 998 dental patient charts were included in the study. All the patients underwent the same clinical protocol. Possible associations between postoperative pain and clinical variables were investigated, including age, gender, type of tooth, type of treatment, pulpal diagnosis, periradicular diagnosis, instrumentation system used, number of sessions, previous symptom, procedural accident, and endodontic sealer extrusion. Patients were contacted by telephone 24 h and 7 days after treatment completion and were asked about the degree of postoperative pain they had experienced, using a four-level scoring system: 0, no pain; 1, mild pain (no medication was needed); 2, moderate pain (an analgesic or anti-inflammatory was needed); 3, severe pain. Fischer's exact test, Pearson's test, and logistic regression were used for the statistical analysis of the data. A significance level of 0.05 was used.
A total of 8.6% of the patients reported having experienced postoperative pain, 50% of which reported mild pain, 47.7%, moderate pain, and 2.3%, severe pain. The only variable significantly associated with postoperative endodontic pain was pre-endodontic treatment symptoms (Pearson's test, =0.0047). The logistic regression analysis indicated that the association between use of the Reciproc system and sealer extrusion posed a significant risk for postoperative endodontic pain.
Based on this retrospective cohort study, the incidence of moderate and severe pain after endodontic treatment was low, and the only variable associated with a higher frequency of patients reporting postoperative endodontic pain was previous pain/symptoms. Therefore, in these cases, pain management methods such as the use of analgesics before treatment or immediately after treatment should be considered.
本研究旨在评估2016年6月至2017年12月牙髓病学研究生进行牙髓治疗后,预先确定的临床变量与术后疼痛表现之间的可能关联。
本研究共纳入998份牙科患者病历。所有患者均接受相同的临床方案。研究了术后疼痛与临床变量之间的可能关联,包括年龄、性别、牙齿类型、治疗类型、牙髓诊断、根尖周诊断、使用的器械系统、治疗次数、先前症状、操作意外以及牙髓封闭剂挤出情况。在治疗完成后24小时和7天通过电话联系患者,询问他们经历的术后疼痛程度,采用四级评分系统:0分,无疼痛;1分,轻度疼痛(无需用药);2分,中度疼痛(需要使用镇痛药或抗炎药);3分,重度疼痛。采用费舍尔精确检验、皮尔逊检验和逻辑回归对数据进行统计分析。显著性水平设定为0.05。
共有8.6%的患者报告经历了术后疼痛,其中50%报告轻度疼痛,47.7%报告中度疼痛,2.3%报告重度疼痛。与牙髓术后疼痛显著相关的唯一变量是牙髓治疗前的症状(皮尔逊检验,P = 0.0047)。逻辑回归分析表明,使用Reciproc系统和封闭剂挤出之间的关联对牙髓术后疼痛构成显著风险。
基于这项回顾性队列研究,牙髓治疗后中度和重度疼痛的发生率较低,与报告牙髓术后疼痛的患者频率较高相关的唯一变量是先前的疼痛/症状。因此,在这些情况下,应考虑诸如治疗前或治疗后立即使用镇痛药等疼痛管理方法。