Improving the endodontic patient’s treatment experience
Featured Products Promotional FeaturesPosted by: Dental Design 28th February 2024
There is a widespread perception among the general public that endodontic treatment is painful. It is a procedure that often triggers concern and fear in patients, which makes our job as the professional performing root canal treatment all the more difficult. The actual incidence of pain is largely unknown, with estimates suggesting postoperative pain occurs in anything between 3% and 69% of patients.[i]
Several studies and research papers have looked into methods for reducing possible pain and discomfort, as well as generally enhancing the patient experience. It’s important to be aware of the techniques and technologies that can be implemented in practice to achieve this while generally improving the endodontic patient’s journey.
Changing perceptions
One study[ii] found that the severity of pain expected by the patient was much higher than the actual pain experienced. There was also a statistically significant correlation between the anticipated pain intensity and the level of anxiety felt. The paper concluded that dental professionals should look to reduce the patient’s concerns prior to endodontic treatment in order to improve their experience and lower the pain they expect to feel. This may be achieved by building patient rapport, encouraging their confidence in the treatment itself and providing clear information on what to expect. Though this may not have any impact on the actual amount of pain or discomfort a patient feels during or after endodontic treatment, it will go a long way to creating a more positive treatment journey.
Pain management
As is common with most root canal therapy in the UK, administrating appropriate analgesia before treatment has been shown to reduce postoperative pain. This might include non-steroidal, anti-inflammatory drugs (NSAIDs) that are designed to block pain signals. Peri-operative dexamethasone has also been shown to reduced intra- and post-operative pain. Effective local anaesthetic provided during treatment can also lower the impact of postoperative pain when providing non-surgical therapy.[iii]
Occlusal reduction
Occlusal reduction involves the removal of occlusal contacts so as to minimise the impact on the periodontal ligament and lessen the risk of mechanical allodynia. This is an evolving area of research, but there are initial studies[iv] to suggest that occlusal reduction following endodontic treatment could reduce postoperative pain in the days after the procedure. However, there is only some evidence in very specific cases of irreversible pulpitis and apical periodontitis so more research is needed in this area.
Treatment technique and tools
The clinical techniques employed during endodontic treatment warrant consideration in order to optimise predictability and quality of the outcome achieved, but also to positively affect the patient experience. For example, we should take steps to avoid excessive instrumentation and extrusion of root canal debris past the apical foramen, as this can cause iatrogenic periapical discomfort.[v] Mechanical and chemical damage to the tissue should also be actively prevented, reducing the inflammatory response.
Technological assistance
Linked to this is the use of cutting-edge technology. Rotary systems have been associated with lower postoperative endodontic pain.[vi] Research has shown similar success rates with rotary and manual instrumentation, though the former may be achievable in a shorter treatment time[vii] and with greater predictability – reducing chair time for patients for greater satisfaction.
Several other technologies have evolved and continue to be developed to support endodontic treatment and improve the patient’s perception of the procedure. These include radiographic and CBCT imaging units, 3D printers and digital impression scanners – with the added benefit of integration with artificial intelligence (AI) in some situations. All of these solutions promote accuracy and predictability for everything from diagnostics to treatment planning, surgical or non-surgical treatment or retreatment, and restoration, reducing the risk of complications and alleviating unnecessary postoperative pain. They also make it possible to minimise treatment time and enhance communication with the patient, further improving the patient journey.
Though this is a very promising field with several potential applications within endodontics, it is worth noting that not all technologies are 100% ready to be utilised in every situation. Some refinement is still needed, for example, in the accuracy of intraoral scanners, if we are to use them for precise occlusal management alongside endodontic therapy.
Putting the patient at the heart of endodontics
Colleagues who share my desire to achieve high-quality endodontic treatment outcomes will be familiar with many of the clinical challenges faced every day. In addition to managing and overcoming these, it is just as important that we consider the patient experience throughout treatment. The ultimate goal is to reduce postoperative pain, help them feel less anxious about the procedure and utilise the right techniques and technologies to minimise the risk of complication.
Author: Dr Alyn Morgan, President of the BES.
[i] AlRahabi MK. Predictors, prevention, and management of postoperative pain associated with nonsurgical root canal treatment: A systematic review. J Taibah Univ Med Sci. 2017 May 9;12(5):376-384. doi: 10.1016/j.jtumed.2017.03.004. PMID: 31435267; PMCID: PMC6695063.
[ii] Perković I, Romić MK, Perić M, Krmek SJ. The Level of Anxiety and Pain Perception of Endodontic Patients. Acta Stomatol Croat. 2014 Dec;48(4):258-67. doi: 10.15644/asc47/4/3. PMID: 27688374; PMCID: PMC4872819.
[iii] AlRahabi MK. Predictors, prevention, and management of postoperative pain associated with nonsurgical root canal treatment: A systematic review. J Taibah Univ Med Sci. 2017 May 9;12(5):376-384. doi: 10.1016/j.jtumed.2017.03.004. PMID: 31435267; PMCID: PMC6695063.
[iv] Nguyen D, Nagendrababu V, Pulikkotil SJ, Rossi-Fedele G. Effect of occlusal reduction on postendodontic pain: A systematic review and meta-analysis of randomised clinical trials. Aust Endod J. 2020 Aug;46(2):282-294. doi: 10.1111/aej.12380. Epub 2019 Oct 22. PMID: 31638301.
[v] Law A.S., Nixdorf D.R., Aguirre A.M., Reams G.J., Tortomasi A.J., Manne B.D., Harris D. Predicting severe pain after root canal therapy in the National Dental PBRN. J. Dent. Res. 2015;94:37–43. doi: 10.1177/0022034514555144
[vi] da Silveira MT, Batista SM, Mamede Veloso SR, de Oliveira NG, de Vasconcelos Carvalho M, de Melo Monteiro GQ. Effect of Reciprocating and Rotary Systems on Postoperative Pain: A Systematic Review and Meta-Analysis. Iran Endod J. 2021;16(1):1-16. doi: 10.22037/iej.v16i1.27944. PMID: 36704409; PMCID: PMC9709880.
[vii] Manchanda, S, Sardana, D, Yiu, CKY. A systematic review and meta-analysis of randomized clinical trials comparing rotary canal instrumentation techniques with manual instrumentation techniques in primary teeth. International Endodontic Journal, 53, 333–353, 2020.
