Frequency of Persistent Tooth Pain after Root Canal Therapy: A Systematic Review and Meta-Analysis

Nixdorf, Donald R.; Moana-Filho, Estephan J.; Law, Alan S.; McGuire, Lisa A.; Hodges, James S.; John, Mike T.

doi:10.1016/j.joen.2009.11.007

« Previous Next »Journal of Endodontics
Volume 36, Issue 2 , Pages 224-230, February 2010

Frequency of Persistent Tooth Pain after Root Canal Therapy: A Systematic Review and Meta-Analysis

Donald R. Nixdorf, DDS, MS
- Division of TMD and Orofacial Pain, School of Dentistry, University of Minnesota, Minneapolis, MN
- Department of Neurology, Medical School, University of Minnesota, Minneapolis, MN
- Address requests for reprints to Dr Donald Nixdorf, University of Minnesota, 6-320 Moos Tower, 515 Delaware Street SE, Minneapolis, MN 55455.
Estephan J. Moana-Filho, DDS
- Division of TMD and Orofacial Pain, School of Dentistry, University of Minnesota, Minneapolis, MN
- Center for Neurosensory Disorders, School of Dentistry, University of North Carolina, Chapel Hill, NC
Alan S. Law, DDS, PhD
- Private Practice, The Dental Specialists, Lake Elmo, MN
Lisa A. McGuire, MLIS
- Bio-Medical Library, University of Minnesota, Minneapolis, MN
James S. Hodges, PhD
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
Mike T. John, DDS, MPH, PhD
- Division of TMD and Orofacial Pain, School of Dentistry, University of Minnesota, Minneapolis, MN
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN

Abstract

Introduction

Little is known about the frequency of persistent pain after endodontic procedures even though pain is a core patient-oriented outcome. We estimated the frequency of persistent pain, regardless of etiology, after endondontic treatment.

Methods

Persistent tooth pain was defined as pain present ≥6 months after endodontic treatment. Endodontic procedures included in the review were pulpectomy, nonsurgical root canal treatment, surgical root canal treatment, and retreatment. Four databases were searched electronically complemented by hand searching. Two independent reviewers determined eligibility, abstracted data, and assessed study quality. A summary estimate of persistent all-cause tooth pain frequency was established by using a random-effects meta-analysis. Using subgroup analyses, we explored the influence of treatment approach (surgical/nonsurgical), longitudinal study design (prospective/retrospective), follow-up rate, follow-up duration, initial treatment versus retreatment, and quality of reporting (Strengthening the Reporting of Observational Studies in Epidemiology rankings) on the pain frequency estimate.

Results

Of 770 articles retrieved and reviewed, 26 met inclusion criteria. A total of 5,777 teeth were enrolled, and 2,996 had follow-up information regarding pain status. We identified 168 teeth with pain and derived a frequency of 5.3% (95% confidence interval, 3.5%-7.2%, p < 0.001) for persistent all-cause tooth pain. High and statistically significant heterogeneity among studies (I² = 80%) was present. In subgroup analysis, prospective studies had a higher pain frequency (7.6%) than retrospectives studies did (0.9%). Quality of study reporting was identified as the most influential reason for study heterogeneity.

Conclusions

The frequency of all-cause persistent tooth pain after endodontic procedures was estimated to be 5.3%, with higher report quality studies suggesting >7%.

Key Words: Frequency, meta-analysis, outcome, pain, root canal therapy, systematic review