Meta-Analysis of Non-Odontogenic Tooth Pain Following Root Canal Therapy: IADR/AADR/CADR 87th General Session

Objectives: Determine the frequency of occurrence of non-odontogenic tooth pain !6 months following endodontic procedures using meta-analysis. Methods: Search was performed in PubMed using keywords associated with pain and endodontic procedures, followed by hand search of relevant articles. Two reviewers following training, with acceptable inter-rater reliability, screened citations and disagreement was adjudicated by an endodontist. Criteria for article selection were: 1) performance of endodontic procedures including pulpectomy and apical surgery but not root desensitization, pulp capping, pulpotomy, or concomitant extraction; 2) procedure performed on human secondary teeth; 3) pain was reported as related to the area of the treated tooth including provoked pain such as tenderness with percussion, palpation or biting with concomitant report of no apparent local etiology; and 4) follow up duration of !6 months. Quality of reported research was determined by applying modified STROBE criteria. Consensus between reviews was required on all criteria. Logistic regression with random effects was used to derive a pooled estimate. Results: 736 articles were identified, published between 1921 and 2008. Inter-rater reliability was good ("=0.79). Review revealing 14 articles that met criteria, 6 with fair-good quality and 8 with marginal quality. Notable publications did not meet the selection criteria. A total of 3,747 teeth were enrolled with 1,403 being followed (37%). 48 teeth had non-odontogenic pain; meta-analysis estimated occurrence of 0.9% (95% CI=0.3-1.6%). Duration of follow-up (p=0.001) influenced estimates, while type of procedure did not (p=0.278). Conclusions: Together 14 articles suggest a frequency of occurrence of non-odontogenic tooth pain to be 0.9% following all types of root canal therapy, which is higher than typical clinical impression. Large prospective cohort studies with rigorous criteria are needed to further verify these results. Supported by NCRR K12-RR023247 (DR Nixdorf)