Abstract
Introduction
Thorough pain assessment and thermal and mechanical testing are the primary diagnostic
tools used to assess the status of pulp and periapical tissues in teeth with potential
endodontic pathology. This study evaluated predictors of acute odontogenic pain to
better understand the relationship between endodontic pain, clinical testing, endodontic
disease, and diagnoses.
Methods
Participants (N = 228) presenting with acute odontogenic pain underwent standardized clinical testing
and reported their pain intensity. Univariate and multiple regression analyses were
performed to evaluate the predictors of acute endodontic pain. Chi-square tests with
Bonferroni adjustments were conducted to measure the frequency of endodontic diagnostic
test findings and clinical observations in patients with different pulpal diagnoses.
Results
A negative response to cold stimulation on the causative tooth and percussion hypersensitivity
on the healthy adjacent tooth were the strongest predictors of higher levels of acute
endodontic pain. Percussion hypersensitivity on the healthy adjacent tooth was present
in a quarter of the cohort and was reported with equal frequency in teeth diagnosed
with irreversible pulpitis, necrotic pulp, and previously initiated/treated teeth.
Although painful percussion on the causative tooth was more frequently reported in
teeth diagnosed with necrotic pulp, painful palpation was more frequently reported
on teeth diagnosed with previously initiated/treated teeth.
Conclusions
Percussion hypersensitivity on the healthy adjacent tooth may reveal a lowered pain
threshold and heightened pain sensitization. It is also possible that the 2 commonly
performed mechanical sensory tests, percussion and palpation hypersensitivity, may
detect different aspects of endodontic pathophysiology and pain processing.
Key Words
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Article info
Publication history
Published online: July 10, 2021
Identification
Copyright
© 2021 American Association of Endodontists.
