title: Diagnostic and clinical factors associated with pulpal and periapical pain.
abstract: A retrospective survey was designed to identify diagnostic subgroups and clinical factors associated with odontogenic pain and discomfort in dental urgency patients. A consecutive sample of 1,765 patients seeking treatment for dental pain at the Urgency Service of the Dental School of the Federal University of Goiás, Brazil, was selected. Inclusion criteria were pulpal or periapical pain that occurred before dental treatment (minimum 6 months after the last dental appointment), and the exclusion criteria were teeth with odontogenic developmental anomalies and missing information or incomplete records. Clinical and radiographic examinations were performed to assess clinical presentation of pain complaints including origin, duration, frequency and location of pain, palpation, percussion and vitality tests, radiographic features, endodontic diagnosis and characteristics of teeth. Chi-square test and multiple logistic regression were used to analyze association between pulpal and periapical pain and independent variables. The most frequent endodontic diagnosis of pulpal pain were symptomatic pulpitis (28.3%) and hyperreactive pulpalgia (14.4%), and the most frequent periapical pain was symptomatic apical periodontitis of infectious origin (26.4%). Regression analysis revealed that closed pulp chamber and caries were highly associated with pulpal pain and, conversely, open pulp chamber was associated with periapical pain (p<0.001). Endodontic diagnosis and local factors associated with pulpal and periapical pain suggest that the important clinical factor of pulpal pain was closed pulp chamber and caries, and of periapical pain was open pulp chamber.
authors.affiliation: Dental School, UFG - Federal University of Goiás, Goiânia, GO, Brazil. estrela3@terra.com.br
authors.forename: Carlos
authors.initials: C
authors.lastname: Estrela
authors.forename: Orlando Aguirre
authors.initials: OA
authors.lastname: Guedes
authors.forename: Júlio Almeida
authors.initials: JA
authors.lastname: Silva
authors.forename: Cláudio Rodrigues
authors.initials: CR
authors.lastname: Leles
authors.forename: Cyntia Rodrigues de Araújo
authors.initials: CR
authors.lastname: Estrela
authors.forename: Jesus Djalma
authors.initials: JD
authors.lastname: Pécora
mesh_terms: D000328:Adult; D003731:Dental Caries / Q000175:diagnosis; D003751:Dental Fistula / Q000175:diagnosis; D003788:Dental Pulp Diseases / Q000175:diagnosis*; D003791:Dental Pulp Test; D003793:Dental Restoration, Permanent; D003794:Dental Restoration, Temporary; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D010147:Pain Measurement; D010173:Palpation; D010474:Percussion; D010482:Periapical Abscess / Q000175:diagnosis; D010483:Periapical Diseases / Q000175:diagnosis*; D010485:Periapical Periodontitis / Q000175:diagnosis; D011176:Post and Core Technique; D011671:Pulpitis / Q000175:diagnosis; D012189:Retrospective Studies; D012307:Risk Factors; D012390:Root Canal Therapy; D013997:Time Factors; D014082:Tooth Fractures / Q000175:diagnosis; D014098:Toothache / Q000175:diagnosis*