Pulp Vitality and Percussion Sensitivity Associate With Patient-Reported Pain Descriptors

Objectives: Endodontic diagnosis collectively relies on interpretation of chair-side clinical testing and pain history to assess the presence of inflammation in the pulp and periapical tissues. Whether clinical findings relate to a patient’s subjective pain description is largely unknown. This study evaluated the association between pulp vitality and percussion sensitivity, and patients’ ratings of various pain qualities.
Methods: Participants (n= 228) were recruited from among those presenting with toothache at a dental emergency clinic. Clinical testing (cold, EPT, percussion, palpation, and bite) was completed by calibrated examiners and participants verbally rated their pain intensity with reference to 22 pain qualities (0-10 VAS). Two-way ANOVA determined the relationship between groups defined by pulp vitality and percussion sensitivity and the intensity rating of each pain descriptor.
Results: Patients experiencing toothache from a tooth with a vital pulpal status reported higher levels of shooting pain (p<0.05). By contrast, patients experiencing toothache with hypersensitivity to percussion reported higher levels of radiating and throbbing pain, as well as pain when chewing, or with exposure to cold, than those normally sensitive to percussion (all p<0.05). No significant interaction effects were identified.
Conclusions: Shooting pain is more salient in odontalgia patients with a vital pulp diagnosis, and may be a unique feature of pulp mediated pain. Radiating, throbbing, and evoked pain are associated with percussion sensitivity and could reflect central sensitization or more advanced inflammatory processes. As pain is an individual and multidimensional experience, a detailed pain history including pain descriptors may help improve endodontic diagnosis and distinguish the underlying biological mechanisms in different stages of the disease.