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ENDODONTIC TREATMENT OUTCOMES: DO PATIENTS PERCEIVE PROBLEMS?
Downloaded from jada.ada.org on December 11, 2014
Endodontic treatment outcomes: do patients perceive problems? WK Lobb, KL Zakariasen and PJ McGrath JADA 1996;127(5):597-600 10.14219/jada.archive.1996.0271 The following resources related to this article are available online at jada.ada.org (this information is current as of December 11, 2014): Updated information and services including high-resolution figures, can be found in the online version of this article at: http://jada.ada.org/content/127/5/597
This article appears in the following subject collections: Endodontics http://jada.ada.org/cgi/collection/endodontics Information about obtaining reprints of this article or about permission to reproduce this article in whole or in part can be found at: http://www.ada.org/990.aspx
Copyright © 2014 American Dental Association. All rights reserved. Reproduction or republication strictly prohibited without prior written permission of the American Dental Association. The sponsor and its products are not endorsed by the ADA.
Downloaded from jada.ada.org on December 11, 2014
COV E R
S T O RY
*ENDODONTIC
TRlEATMENT *OUTrcoMEs : DO PATIENTS PERCEIVE *PROBLEMS ? WILLIAM K. LOBB, D.D.S. M.S; KENNETH L. ZAKARIASEN, D.D.S., PH.D., M.S.; PATRICK J. MCGRATH, PH.D.
: hile the endodontic literature addresses some aspects of endodontically related pain, the complete nature of preoperative, intraoperative and postoperative pain has not been fully described.1-8 Knowledge of the complete nature of endodontically related pain might make possible the development of predictive models for intraoperative and postoperative pain. Such models would allow effective prophylactic treatment of endodontic pain. In 1993, we studied the nature of preoperative, intraoperative and postoperative endodontic pain in a clinical study of 198 consecutive patients who received endodontic treatment.9"0 These patients were obtained from a five-practitioner endodontic practice (co-author K.L.Z. was a member of this practice). A research assistant trained in interviewing techniques interviewed each patient immediately after his or her endodontic appointment in a private area at the endodontic practice. Each patient was questioned about his or her general and dental pain history, any preoperative pain related to the tooth being treated, pain during the treatment and other related factors. JADA, Vol. 127, May 1996 597
~COVER STORY
Downloaded from jada.ada.org on December 11, 2014
TABLE I
are now studying through stepwise multiple regression analysis. The goal is to ascertain which factors may be significantly correlated with intraoperative and postoperative pain experience for predictive modeling purposes. In reviewing the endodontic literature, we found that longterm follow-up of patients after therapy has not been done to ascertain whether patients perceive that they have problems related to their endodontically treated teeth. This report addresses that issue as a continuation of the study of these 198
patients." PURPOSE
The purpose of this study was to assess patients' perceptions of their endodontic treatment outcomes during a one-year follow-up period relative to any long-term problems that may have developed. As part of our research to study pain patterns in patients before, during and after endodontic therapy, we contacted a group of patients about one year after therapy and asked them to respond to a series of standardized questions.
TABLE 2
MATERIALS AND
MIETHODS
The interviewer gave each patient a form on which to record postoperative pain during the three days following the appointment. Patients mailed the completed forms to the authors. In addition, each endodontist completed a form for each of the patients treated, which included a diagnosis, 598 JADA, Vol. 127, May 1996
signs and symptoms observed, procedures accomplished, anesthetics used and pain medications and antibiotics prescribed. The data collected about each patient through the interview, the medical history, the attending dentist's report and the post-treatment pain forms uncovered many factors, which we
A single trained interviewer attempted to contact all of the 198 patients who participated in our original study. She reached 165 (83 percent) of them and surveyed them by telephone approximately one year after the completion of endodontic procedures related to a single tooth. The remaining 33 patients could not be contacted because some of them had moved and we did not have a current telephone number for others. All of the patients who
Downloaded from jada.ada.org on December 11, 2014
COVER STORY could be reached agreed to respond to the telephone survey. The interviewer asked the patients a series of questions related to their experiences since the completion of endodontic therapy. In our original study, patients reported the occurrence and magnitude of pain or discomfort that occurred through the third day after treatment. The present study examined patients' perceptions of any problems that occurred after the immediate post-treatment period through approximately one year after treatment.
TABLE 3
RESULTS
Patients' responses to the telephone survey questions are summarized in Tables 1 through 3. Overall, about one in five respondents reported that they had problems related to their endodontically treated tooth during the year following the procedure. The problems most often reported related to pain experience and restorative concerns.
The results of this study indicate that there is a relatively high frequency of perceived problems in the year following endodontic therapy. Almost all
reported in this study were often related to fracture of a portion of the clinical crown or restoration, or to loss of the temporary filling. In most cases, the problem could have been solved with a new coronal restoration. However, in a few cases, patients reported that the tooth was ultimately extracted because of the severity of the fracture. Surprisingly, most of the patients who experienced problems did not seek treatment by revisiting their endodontist.
of these problems are related to pain and restorative concerns. These problems should be of significant interest to dentists who provide endodontic treatment. The restorative problems
Some may have sought treatment from their general practitioner. However, only a few reported doing so, and it is likely that their pain problems, at least, were minimal and re-
DISCUSSION
solved themselves. One of the authors (K.L.Z.) has treated many patients over the years who reported that it took a number of months for a successfully treated tooth to become completely asymptomatic. We should note that the pain symptoms reported by the patients in this study were minimal-that is, slight sensitivity to masticatory pressures or a response of "It doesn't really hurt, but it feels different from my other teeth." None of the pain problems was acute and no other signs or symptoms were evident. Dentists need to review data such as those collected in this study and apply the findings to the management of endodontic problems. For example, fracture of the tooth, fracture of the permanent restoration or loss of temporary cement suggests that we more strongly emphasize
restorations that provide cuspal protection and that are placed in a timely fashion after the completion of endodontic therapy. In addition, the continuation or development of minor JADA, Vol. 127, May 1996 599
Downloaded from jada.ada.org on December 11, 2014
C~KOVER STORY
Dr. Lobb is assistant dean for Education and Patient Care and an associate professor, Department of Developmental Science and Community Heath, Marquette University: School of Dentistry, Milwaukee.
Dr. Zakarlasen Is dean and a professor, Marquette University School of Dentistry, 604 N. 16th St., Milwaukee, Wis. 53233, and executive directorelect, California Dental Association. Address reprlnt requests to Dr. Zakariasen.
discomfort after the immediate post-treatment period (that is, after the first three days) should be recognized, although it appears relatively infrequently. If dentists warn patients that this problem can occur, they are less likely to be surprised or unduly concerned if it does. CONCLUSION
In this study, we found that a significant number of patients
600 JADA, Vol. 127, May 1996
(approximately one in five) perceived that they had problems related to their endodonDr. McGrath Is directically treated tor and a professor, tooth during Clinical Psychology Ph.D. Program, Dethe year followpartment of Psythe proceing chology, Dalhousle dure. However, University, Hallfax, Nova Scotia, the majority of Canada. patients who perceived problems did not, in fact, revisit the endodontist in response to them. The study also revealed that the majority of patients who received endodontic treatment would undergo this treatment again if their dentist recommended it; for those few who would not, pain and expense appeared to be the greatest deterrents. . 1. Clem WH. Posttreatment endodontic pain. JADA 1970;81:1166-70. 2. Fox J, Atkinson JS, Dinin AP, et al. Incidence of pain following one-visit endodontic treatment. Oral Surg Oral Med Oral Pathol 1970;30:123-30.
3. O'Keefe EM. Pain in endodontic therapy: preliminary study. J Endod 1976;2(10):315-19. 4. Roane JB, Dryden JA, Grimes EW. Incidence of postoperative pain after single- and multiple-visit endodontic procedures. Oral Surg Oral Med Oral Pathol 1983;55(5):68-72. 5. Seltzer S, Bender IB, Ehrenreich J. Incidence and duration of pain following endodontic therapy. Oral Surg Oral Med Oral Pathol 1961;14:74-82. 6. Martin H, Cunningham WT. An evaluation of postoperative pain incidence following endosonic and conventional root canal therapy. Oral Surg Oral Med Oral Pathol 1982;54:74-6. 7. Cunningham CJ, Mullaney TP. Pain control in endodontics. Dent Clin North Am 1992; 36:393-408. 8. Dubner R. Oro-facial pain mechanisms. In: Arens D, Martin H, eds. Conference on drug therapy. Chicago: American Association of Endodontists Endowment and Memorial Foundation; 1979:9-23. 9. Lobb WK, Zakariasen KL, McGrath PJ, Barkley DL, Griffith PA. A clinical study of pre-treatment pain in endodontic patients (Abstract no. 1687). J Dent Res 1993;72:314. 10. Zakariasen KL, Lobb WK, McGrath PJ. Expected pain as a predictor of observed posttreatment pain (Abstract no. 256). J Dent Res 1995;74:43. 11. Lobb WK, Zakariasen KL, McGrath PJ. Patient perceptions of endodontic treatment outcomes (Abstract no. 1687). J Dent Res 1994;73:139.
Endodontic treatment outcomes: do patients perceive problems? WK Lobb, KL Zakariasen and PJ McGrath JADA 1996;127(5):597-600 10.14219/jada.archive.1996.0271 The following resources related to this article are available online at jada.ada.org (this information is current as of December 11, 2014): Updated information and services including high-resolution figures, can be found in the online version of this article at: http://jada.ada.org/content/127/5/597
This article appears in the following subject collections: Endodontics http://jada.ada.org/cgi/collection/endodontics Information about obtaining reprints of this article or about permission to reproduce this article in whole or in part can be found at: http://www.ada.org/990.aspx
Copyright © 2014 American Dental Association. All rights reserved. Reproduction or republication strictly prohibited without prior written permission of the American Dental Association. The sponsor and its products are not endorsed by the ADA.
Downloaded from jada.ada.org on December 11, 2014
COV E R
S T O RY
*ENDODONTIC
TRlEATMENT *OUTrcoMEs : DO PATIENTS PERCEIVE *PROBLEMS ? WILLIAM K. LOBB, D.D.S. M.S; KENNETH L. ZAKARIASEN, D.D.S., PH.D., M.S.; PATRICK J. MCGRATH, PH.D.
: hile the endodontic literature addresses some aspects of endodontically related pain, the complete nature of preoperative, intraoperative and postoperative pain has not been fully described.1-8 Knowledge of the complete nature of endodontically related pain might make possible the development of predictive models for intraoperative and postoperative pain. Such models would allow effective prophylactic treatment of endodontic pain. In 1993, we studied the nature of preoperative, intraoperative and postoperative endodontic pain in a clinical study of 198 consecutive patients who received endodontic treatment.9"0 These patients were obtained from a five-practitioner endodontic practice (co-author K.L.Z. was a member of this practice). A research assistant trained in interviewing techniques interviewed each patient immediately after his or her endodontic appointment in a private area at the endodontic practice. Each patient was questioned about his or her general and dental pain history, any preoperative pain related to the tooth being treated, pain during the treatment and other related factors. JADA, Vol. 127, May 1996 597
~COVER STORY
Downloaded from jada.ada.org on December 11, 2014
TABLE I
are now studying through stepwise multiple regression analysis. The goal is to ascertain which factors may be significantly correlated with intraoperative and postoperative pain experience for predictive modeling purposes. In reviewing the endodontic literature, we found that longterm follow-up of patients after therapy has not been done to ascertain whether patients perceive that they have problems related to their endodontically treated teeth. This report addresses that issue as a continuation of the study of these 198
patients." PURPOSE
The purpose of this study was to assess patients' perceptions of their endodontic treatment outcomes during a one-year follow-up period relative to any long-term problems that may have developed. As part of our research to study pain patterns in patients before, during and after endodontic therapy, we contacted a group of patients about one year after therapy and asked them to respond to a series of standardized questions.
TABLE 2
MATERIALS AND
MIETHODS
The interviewer gave each patient a form on which to record postoperative pain during the three days following the appointment. Patients mailed the completed forms to the authors. In addition, each endodontist completed a form for each of the patients treated, which included a diagnosis, 598 JADA, Vol. 127, May 1996
signs and symptoms observed, procedures accomplished, anesthetics used and pain medications and antibiotics prescribed. The data collected about each patient through the interview, the medical history, the attending dentist's report and the post-treatment pain forms uncovered many factors, which we
A single trained interviewer attempted to contact all of the 198 patients who participated in our original study. She reached 165 (83 percent) of them and surveyed them by telephone approximately one year after the completion of endodontic procedures related to a single tooth. The remaining 33 patients could not be contacted because some of them had moved and we did not have a current telephone number for others. All of the patients who
Downloaded from jada.ada.org on December 11, 2014
COVER STORY could be reached agreed to respond to the telephone survey. The interviewer asked the patients a series of questions related to their experiences since the completion of endodontic therapy. In our original study, patients reported the occurrence and magnitude of pain or discomfort that occurred through the third day after treatment. The present study examined patients' perceptions of any problems that occurred after the immediate post-treatment period through approximately one year after treatment.
TABLE 3
RESULTS
Patients' responses to the telephone survey questions are summarized in Tables 1 through 3. Overall, about one in five respondents reported that they had problems related to their endodontically treated tooth during the year following the procedure. The problems most often reported related to pain experience and restorative concerns.
The results of this study indicate that there is a relatively high frequency of perceived problems in the year following endodontic therapy. Almost all
reported in this study were often related to fracture of a portion of the clinical crown or restoration, or to loss of the temporary filling. In most cases, the problem could have been solved with a new coronal restoration. However, in a few cases, patients reported that the tooth was ultimately extracted because of the severity of the fracture. Surprisingly, most of the patients who experienced problems did not seek treatment by revisiting their endodontist.
of these problems are related to pain and restorative concerns. These problems should be of significant interest to dentists who provide endodontic treatment. The restorative problems
Some may have sought treatment from their general practitioner. However, only a few reported doing so, and it is likely that their pain problems, at least, were minimal and re-
DISCUSSION
solved themselves. One of the authors (K.L.Z.) has treated many patients over the years who reported that it took a number of months for a successfully treated tooth to become completely asymptomatic. We should note that the pain symptoms reported by the patients in this study were minimal-that is, slight sensitivity to masticatory pressures or a response of "It doesn't really hurt, but it feels different from my other teeth." None of the pain problems was acute and no other signs or symptoms were evident. Dentists need to review data such as those collected in this study and apply the findings to the management of endodontic problems. For example, fracture of the tooth, fracture of the permanent restoration or loss of temporary cement suggests that we more strongly emphasize
restorations that provide cuspal protection and that are placed in a timely fashion after the completion of endodontic therapy. In addition, the continuation or development of minor JADA, Vol. 127, May 1996 599
Downloaded from jada.ada.org on December 11, 2014
C~KOVER STORY
Dr. Lobb is assistant dean for Education and Patient Care and an associate professor, Department of Developmental Science and Community Heath, Marquette University: School of Dentistry, Milwaukee.
Dr. Zakarlasen Is dean and a professor, Marquette University School of Dentistry, 604 N. 16th St., Milwaukee, Wis. 53233, and executive directorelect, California Dental Association. Address reprlnt requests to Dr. Zakariasen.
discomfort after the immediate post-treatment period (that is, after the first three days) should be recognized, although it appears relatively infrequently. If dentists warn patients that this problem can occur, they are less likely to be surprised or unduly concerned if it does. CONCLUSION
In this study, we found that a significant number of patients
600 JADA, Vol. 127, May 1996
(approximately one in five) perceived that they had problems related to their endodonDr. McGrath Is directically treated tor and a professor, tooth during Clinical Psychology Ph.D. Program, Dethe year followpartment of Psythe proceing chology, Dalhousle dure. However, University, Hallfax, Nova Scotia, the majority of Canada. patients who perceived problems did not, in fact, revisit the endodontist in response to them. The study also revealed that the majority of patients who received endodontic treatment would undergo this treatment again if their dentist recommended it; for those few who would not, pain and expense appeared to be the greatest deterrents. . 1. Clem WH. Posttreatment endodontic pain. JADA 1970;81:1166-70. 2. Fox J, Atkinson JS, Dinin AP, et al. Incidence of pain following one-visit endodontic treatment. Oral Surg Oral Med Oral Pathol 1970;30:123-30.
3. O'Keefe EM. Pain in endodontic therapy: preliminary study. J Endod 1976;2(10):315-19. 4. Roane JB, Dryden JA, Grimes EW. Incidence of postoperative pain after single- and multiple-visit endodontic procedures. Oral Surg Oral Med Oral Pathol 1983;55(5):68-72. 5. Seltzer S, Bender IB, Ehrenreich J. Incidence and duration of pain following endodontic therapy. Oral Surg Oral Med Oral Pathol 1961;14:74-82. 6. Martin H, Cunningham WT. An evaluation of postoperative pain incidence following endosonic and conventional root canal therapy. Oral Surg Oral Med Oral Pathol 1982;54:74-6. 7. Cunningham CJ, Mullaney TP. Pain control in endodontics. Dent Clin North Am 1992; 36:393-408. 8. Dubner R. Oro-facial pain mechanisms. In: Arens D, Martin H, eds. Conference on drug therapy. Chicago: American Association of Endodontists Endowment and Memorial Foundation; 1979:9-23. 9. Lobb WK, Zakariasen KL, McGrath PJ, Barkley DL, Griffith PA. A clinical study of pre-treatment pain in endodontic patients (Abstract no. 1687). J Dent Res 1993;72:314. 10. Zakariasen KL, Lobb WK, McGrath PJ. Expected pain as a predictor of observed posttreatment pain (Abstract no. 256). J Dent Res 1995;74:43. 11. Lobb WK, Zakariasen KL, McGrath PJ. Patient perceptions of endodontic treatment outcomes (Abstract no. 1687). J Dent Res 1994;73:139.