Persistent Pain and Root Canal Therapy

Dentists perform over 16.4 million root canal therapies every year in the United States (American Dental Association, 2002). Persistent tooth pain, which is pain present 6 months after root canal therapy, is known to occur following root canal therapy in a fashion similar to other post-surgical pains, such as phantom limb pain. Research in this area is limited, but suggests a frequency of occurrence of 3% to 12% for persistent post-root canal pain. Despite the commonality of root canal treatment, the occurrence and severity of persistent tooth pain and extent of interference with daily life from this condition has not been well studied in dental care populations. Adequate treatments for some of these pains are emerging, and early identification and treatment may improve prognosis, but the first step is to determine how widespread the problem is and how severely it affects dental patients. This knowledge is expected to influence patient and provider decisions about dental treatment and to facilitate the development of preventative treatment strategies, such as pre-emptive analgesia, aimed at reducing patients’ modifiable peri-operative risk factors. The long-term goal of this line of research is to identify pre-operative factors that put patients at greater risk for developing persistent tooth pain following root canal therapy, thereby providing evidence that will allow dentists to act preventively to mitigate this risk, improve pain control, and increase their patients’ quality of life. For this long-term goal to be realized, future externally funded research using the DPBRN is anticipated; hence, there is a need for pilot data to support the feasibility of such research. Even though this research proposal is focused on understanding the outcomes of root canal therapy, with the long-term goal of improving care, the resultant data may have ramifications for surgical procedures performed elsewhere in the body. Undoubtedly aspects of this research will be specific to root canal therapy, but since pain is a centrally derived phenomenon that affects the whole individual, aspects of the involved pain mechanisms are likely shared with other surgical procedures. Thus, this line of research could have an impact on healthcare in general.