title: Prevalence of persistent pain 3 to 5 years post primary root canal therapy and its impact on oral health-related quality of life: PEARL Network findings.
abstract: BACKGROUND
  The frequency of persistent pain 3-5 years after primary root canal therapy and its impact on the patient's perceived oral health-related quality of life was determined in a practice-based research network.
  
  
  METHODS
  All patients presenting to participating network practices who received primary root canal therapy and restoration for a permanent tooth 3-5 years previously were invited to enroll. Persistent pain was defined as pain occurring spontaneously or elicited by percussion, palpation, or biting. The patient also completed an oral health-related quality of life questionnaire (Oral Health Impact Profile-14).
  
  
  RESULTS
  Sixty-four network practices enrolled 1323 patients; 13 were ineligible, 12 did not receive a final restoration, and 41 were extracted, leaving 1257 for analysis. The average time to follow-up was 3.9 ± 0.6 years. Five percent (63/1257) of the patients reported persistent pain, whereas 24 of 63 (38%) exhibited periapical pathosis and/or root fracture (odontogenic pain). No obvious odontogenic cause for persistent pain was found for 39 of 63 (62%). Teeth treated by specialists had a greater frequency of persistent pain than teeth treated by generalists (9.3% vs 3.0%, respectively; P < .0001). Sex, age, tooth type, type of dentist, and arch were not found to be associated with nonodontogenic persistent pain; however, ethnicity and a preoperative diagnosis of pulpitis without periapical pathosis were. Patients reporting pain with percussion tended to experience pain with other stimuli that negatively impacted quality of life including oral function and psychological discomfort and disability.
  
  
  CONCLUSIONS
  These results suggest that a small percentage (3.1%) of patients experience persistent pain not attributable to odontogenic causes 3-5 years after primary root canal therapy that may adversely impact their quality of life.
authors.affiliation: The EMMES Corporation, Rockville, Maryland; PEARL Network Coordinating Center, New York, New York.
authors.forename: Donald A
authors.initials: DA
authors.lastname: Vena
authors.affiliation: The EMMES Corporation, Rockville, Maryland.
authors.forename: Damon
authors.initials: D
authors.lastname: Collie
authors.affiliation: The EMMES Corporation, Rockville, Maryland.
authors.forename: Hongyu
authors.initials: H
authors.lastname: Wu
authors.affiliation: Department of Endodontics, New York University College of Dentistry, New York, New York.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Gibbs
authors.affiliation: Department of Cariology and Comprehensive Care, New York University College of Dentistry, New York, New York.
authors.forename: Hillary L
authors.initials: HL
authors.lastname: Broder
authors.affiliation: Department of Oral and Maxillofacial Pathology, Radiology, and Medicine, Clinical Pharmacology/Regulatory Affairs, Bluestone Center for Clinical Research, New York University College of Dentistry, New York, New York.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Curro
authors.affiliation: PEARL Network, New York, New York; Department of Biomaterials, Biomemitics and Biophotonics, King's College London Dental Institute, Guy's Hospital, London, United Kingdom.
authors.forename: Van P
authors.initials: VP
authors.lastname: Thompson
authors.affiliation: Department of Basic Sciences and Craniofacial Biology, New York University College of Dentistry, New York, New York; Department of Periodontology and Implant Dentistry, New York University College of Dentistry, New York, New York. Electronic address: rgc1@nyu.edu.
authors.forename: Ronald G
authors.initials: RG
authors.lastname: Craig
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D055812:Community-Based Participatory Research; D005260:Female; D005500:Follow-Up Studies; D005792:General Practice, Dental / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D009909:Oral Health; D010146:Pain / Q000453:epidemiology* / Q000523:psychology; D010483:Periapical Diseases / Q000453:epidemiology / Q000523:psychology; D015995:Prevalence; D011671:Pulpitis / Q000453:epidemiology / Q000523:psychology; D011788:Quality of Life; D012390:Root Canal Therapy / Q000523:psychology / Q000706:statistics & numerical data*; D013039:Specialties, Dental / Q000706:statistics & numerical data; D014082:Tooth Fractures / Q000453:epidemiology / Q000523:psychology; D014092:Tooth Root / Q000293:injuries; D055815:Young Adult
keywords: Dentoalveolar; oral health impact profile; pain; quality of life; root canal therapy; tooth