Pain And Flare-ups In Root-filled Teeth With Persistent Lesions

Objectives: Painful exacerbations of lesions that persist four years or more after obturation have unknown incidence and impact on quality of life. This study examined the incidence and evaluated potential predictive factors of flare-up and lesser pain with impact on ten common daily activities among 185 root-filled teeth with persistent lesions. Methods: Radiographic records from 2004-06 were hand searched to identify root-filled teeth with periapical lesions at the time of treatment and not resolved at earlier recall. These patients were invited to attend a further recall examination to determine if a persistent lesion was present; if so, a clinical examination and questionnaire survey were conducted. Study parameters included clinical features and pain experience. Statistical analysis of patient and treatment factors in association with pain was performed using Chi-square and Mann-Whitney tests. Results: 137 patients with 185 persistent lesions were recruited. 93 persistent lesions were found in female and 92 in male patients. Median age at recruitment was 56 (age range: 21-82). Median time since treatment was 5 years (range: 4-38 years). Flare-up occurred in 5.4% of subjects, while flare-up and/or lesser pain with impact in 20.5%. Pre-operative pain was identified as predictive for lesser pain with impact (p= 0.005). The most commonly affected activities were eating and tooth brushing. Conclusion: The annual risk of flare-up among persistent lesions was very low (about 1%). A lower degree of pain was more common, with minimal impact on daily activities. This study was supported by Singapore MOE grant WBS No. R -224-000-038-133.