No patient has ever wanted a root canal. For one reason or another, in the mind of the patient, it is always associated with pain during and after the procedure. In fact, one study showed patient reports of post-operative pain in almost 60% of cases.
Where does the pain come from?
The role of the practitioner is to reduce the source of pain during the procedure and within the healing/ recovery time following. The main contributing factors for the cause of pain or tenderness following the completion of endodontic treatment is linked to inflammatory mediator release. Releasing bradykinin, cytokines and prostaglandins excites nerve ending in the peripheral space and creates allodynia, through peripheral or central pathways.
Did you reduce occlusion?
Anecdotally, its commonly accepted by practitioners that by reducing the occlusion of the tooth, we are essentially reducing any sort of function/ pressure on the peripheral nerve ending of the tooth, thus reducing pain. However, this still remains a controversy. Many studies have done supporting or refuting the claim. Here we will review those studies, in a systematic review and meta-analysis exploring the effects of occlusal reduction on reduction of pain, compared to no occlusal reduction.
The evidence
344 patients were analyzed following endodontic therapy. The teeth evaluated included vital, non-vital, and teeth with apical periodontitis. The procedures evaluated included both single visit and multi-visit therapies, involving both manual and rotary filing systems. All procedures that were evaluated used sodium hypochlorite as irrigation, however the concentration of the solutions varied. The severities of pain perceived by the patients were documented through subjective rating systems.
The results of this study show no significant difference in pain reported by patients in the first 48 hours following the endodontic procedure, when having occlusal reduction, compared to no occlusal reduction. However, at 72 hours following the procedure, there was a significant reduction in pain with occlusal reduction. Thus it can be extrapolated that slight occlusal reduction can in fact increase the comfort of the recovering patient at 72 hours.
*It should be noted that the studies examined showed a variety of treatment protocols. This variety can in fact contribute differences in perceived pain.
So what?
Independent of the final restoration planned for the tooth, at least 5 days of post operative recovery is recommended following endodontic therapy. During this time, occlusal forces on the tooth should be kept to a minimum through patient compliance and occlusal reduction. After this time the tooth can be restored to its final form and function. This can a profound effect on patient comfort, and how much they like you as a practitioner.