Incidence and Impact of Painful Exacerbations in a Cohort with Post-treatment Persistent Endodontic Lesions

By Yu V, Messer H, Yee R, Shen L

Date: 01/2012
Journal: JOE


Purpose-determine the incidence of painful exacerbation (flare ups or pain impacting daily activities) in a patients identified as having persistent lesions for at least 4 yrs post endo treatment. Patient & treatment factors studied for correlation with occurrence of pain


-had to have PA lesion at least 4 yrs post treatment (NSRCT or NSRETRX included)

-127 patients with 185 teeth fulfilled selection requirement (34 of 185 were from treatments long before the others included in study providing up 38 yr follow up)

-collected demographic data, medical, dental & endo treatment history, pain history since treatment (scored from mild (1) to severe (5))

-also used a modified Oral Impacts on Daily Performances (OIDP) quality of life questionnaire focused on pain on 10 common daily activities: eating/enjoying food, speaking, cleaning teeth, performing light activities, going out, sleeping, relaxing, smiling, laughing, maintaining emotional state, enjoying contact w/ people

-clinical and radiographic evaluation of endo treated teeth evaluated by endodontists


  • 33 patients with 38 (21%) teeth reported painful exacerbations
  • 10 cases (5%) experienced a flare up -cumulative risk for flare up @ 4 yrs was 3%, @10 and 20 yrs it was 6%

-8 of 10 flare ups associated with deteriorating PA lesion

  • 23 patients w/ 28 teeth (15%) had less severe painful episodes that disrupted daily activity – risk was 7% @4 yrs, 30% @10, & 45% @20 yrs

-less painful episodes 10 had deteriorating PA lesions & 13 had improving lesions

  • Found females 2.5x as likely to have pain after endo
  • Persistent lesions associated mandibular molars and maxillary premolars were more likely to have pain post treatment (3.7x more likely)
  • Preoperative pain 3x more likely to have painful exacerbations after treatment
  • 5 cases reported score of 3 or greater in multiple categories on daily life impact –most commonly affected categories were eating and teeth cleaning

Clinical Significance:

A high proportion of endo treated teeth with persistent lesions remain functional with low risk for exacerbations may contribute to a patients reluctance to accept treatment despite persistent infection