The influence of psychological factors on the frequency and perception of post-endodontic pain

Marija Mijailovic; Veljko Kolak

doi:10.2298/VSP231209013M

Marija Mijailovic University Business Academy in Novi Sad, Faculty of Dentistry, Pančevo, Serbia
Veljko Kolak University Business Academy in Novi Sad, Faculty of Dentistry, Pančevo, Serbia https://orcid.org/0000-0002-4178-410X

DOI: https://doi.org/10.2298/VSP231209013M

Keywords: anxiety;, depression;, pain, postoperative;, psychology;, root canal therapy;, stress, psychological;, surveys and questionnaires.

Abstract

Background/Aim. Post-endodontic pain (PEP) is associated with the presence of any uncomfortable feeling or sensitivity that occurs within a few hours or a few days after the endodontic treatment. The aim of this study was to evaluate the possible association between psychological factors and the frequency and perception of PEP. Methods. The study sample consisted of 140 patients with incisors, canines, or premolars indicated for root canal treatment (RCT) without periapical pathology. A single experienced endodontist was involved in the procedure, and the same clinical protocol was used for all the patients. Participants psychometric evaluation was done using the Depression Anxiety Stress Scale 21 (DASS-21). PEP levels were assessed using a Visual Analog Scale at different intervals (24, 48, and 72-hour intervals and after a week). Results. The presence of postoperative pain was reported in 63.6% of the respondents. The vast majority rated the pain intensity as mild, and the pain significantly decreased over evaluated time intervals. Participants who exhibited higher scores for depression, anxiety, and stress reported significantly higher pain intensity. The multivariate logistic regression analysis showed that tooth type (p = 0.001) and high anxiety score (p = 0.035) were directly associated with the occurrence of pain after therapy. Conclusion. Psychological factors, such as depression, stress, and anxiety, influenced pain perception after RCT treatment, and a high anxiety score was directly associated with the frequency of post-obturation pain.

References

Pawar AM, Bhardwaj A, Zanza A, Wahjuningrum DA, Arora S, Luke AM, et al. Severity of Post-Operative Pain after Instru-mentation of Root Canals by XP-Endo and SAF Full Se-quences Compared to Manual Instrumentation: A Random-ized Clinical Trial. J Clin Med 2022; 11(23): 7251.

Hou XM, Su Z, Hou BX. Post endodontic pain following sin-gle-visit root canal preparation with rotary vs reciprocating in-struments: a meta-analysis of randomized clinical trials. BMC Oral Health 2017; 17(1): 86.

Wong AW, Zhang S, Li SK, Zhu X, Zhang C, Chu CH. Inci-dence of post-obturation pain after single-visit versus multi-ple-visit non-surgical endodontic treatments. BMC Oral Health 2015; 15: 96.

Shahi S, Asghari V, Rahimi S, Lotfi M, Samiei M, Yavari H, et al. Postoperative Pain after Endodontic Treatment of Asymp-tomatic Teeth Using Rotary Instruments: A Randomized Clin-ical Trial. Iran Endod J 2016; 11(1): 38–43.

Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain 2020; 161(9): 1976–82.

Sanikop S, Agrawal P, Patil S. Relationship between dental anx-iety and pain perception during scaling. J Oral Sci 2011; 53(3): 341–8.

Sadaf D, Ahmad MZ. Factors associated with postoperative pain in endodontic therapy. Int J Biomed Sci 2014; 10(4): 243–7.

Manczyk B, Gołda J, Biniak A, Reszelewska K, Mazur B, Zając K, et al. Evaluation of depression, anxiety and stress levels in pa-tients with oral lichen planus. J Oral Sci 2019; 61(3): 391–7.

Khademi A, Roohafza H, Iranmanesh P, Yaraghi N, Sichani AV. Association between psychological factors and pain perception in patients with symptomatic irreversible pulpitis during en-dodontic treatment. Giornale Italiano Di Endodonzia 2021; 35(1): 13–9.

Çiçek E, Koçak MM, Koçak S, Sağlam BC, Türker SA. Postoper-ative pain intensity after using different instrumentation tech-niques: a randomized clinical study. J Appl Oral Sci 2017; 25(1): 20–6.

Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther 1995; 33(3): 335–43.

Vujčić I, Safiye T, Milikić B, Popović E, Dubljanin D, Dubljanin E, et al. Coronavirus Disease 2019 (COVID-19) Epidemic and Mental Health Status in the General Adult Population of Ser-bia: A Cross-Sectional Study. Int J Environ Res Public Health 2021; 18(4): 1957.

Kolak V, Pavlovic M, Aleksic E, Biocanin V, Gajic M, Nikitovic A, et al. Probable Bruxism and Psychological Issues among Den-tal Students in Serbia during the COVID-19 Pandemic. Int J Environ Res Public Health 2022; 19(3): 7729.

Santos-Puerta N, Peñacoba-Puente C. Pain and Avoidance during and after Endodontic Therapy: The Role of Pain Anticipation and Self-Efficacy. Int J Environ Res Public Health 2022; 19(3): 1399.

Gomez R, Stavropoulos V, Griffiths MD. Confirmatory factor analysis and exploratory structural equation modelling of the factor structure of the Depression Anxiety and Stress Scales-21. PLoS One 2020; 15(6): e0233998.

Aitken RC. Measurement of feelings using visual analogue scales. Proc R Soc Med 1969; 62(10): 989−93.

Shabbir J, Khurshid Z, Qazi F, Sarwar H, Afaq H, Salman S, et al. Effect of Different Host-Related Factors on Postoperative Endodontic Pain in Necrotic Teeth Dressed with Interap-pointment Intracanal Medicaments: A Multicomparison Study. Eur J Dent 2021; 15(1): 152–7.

Arias A, de la Macorra JC, Azabal M, Hidalgo JJ, Peters OA. Prospective case controlled clinical study of post-endodontic pain after rotary root canal preparation performed by a single operator. J Dent 2015; 43(3): 389–95.

Shaik RP, Chukka RS, Bandlapally A, Vemuri S, Bolla N, Basam RC, et al. Assessment of postoperative pain after single-visit root canal treatment using rotary and reciprocating file sys-tems: an in vivo study. J Dent Anesth Pain Med 2022; 22(4): 267–75.

Oliveira PS, Ferreira MC, Paula NGN, Loguercio AD, Grazziotin-Soares R, da Silva GR, et al. Postoperative Pain Following Root Canal Instrumentation Using ProTaper Next or Reciproc in Asymptomatic Molars: A Randomized Controlled Single-Blind Clinical Trial. J Clin Med 2022; 11(13): 3816.

Maggirias J, Locker D. Psychological factors and perceptions of pain associated with dental treatment. Community Dent Oral Epidemiol 2002; 30(2): 151–9.

Hnatešen D, Radoš I, Dimitrijević I, Budrovac D, Omrčen I, Pavić R, et al. Influence of the Cognitive and Emotional Status of Patients with Chronic Pain on Treatment Success (Reduction in Pain Intensity and Adherence to Pharmacotherapy): A Pro-spective Study. Int J Environ Res Public Health 2022; 19(23): 15968.

Ćeranić J, Glišić B, Petronijević M, Kisic-Tepavčević D, Ristić G. The prevalence of depression/anxiety among patients with rheumatoid arthritis and its relationship with quality of life. Vojnosanit Pregl 2022; 79(10): 970–6.

Yang SE, Park YG, Han K, Min JA, Kim SY. Association be-tween dental pain and depression in Korean adults using the Korean National Health and Nutrition Examination Survey. J Oral Rehabil 2016; 43(1): 51–8.

Schneider E, Hopf D, Eckstein M, Scheele D, Aguilar-Raab C, Herpertz SC, et al. Stress during the COVID-19 Pandemic Moderates Pain Perception and Momentary Oxytocin Levels. J Clin Med 2023; 12(6): 2333.

Sana U, Qureshi IS, Niazi IU, Khan N, Muddassar M, Khattak IK. The association of stress and patient's pain perception dur-ing endodontic therapy. PJMHS 2020; 14(4): 2101–3.

Shibu TM. Post operative pain in endodontics: a systemic re-view. J Dent Oral Hyg 2015; 7(8): 130–7.

Bhardwaj A, Gupta RK, Ates AA, Wahjuningrum DA, Arıcan B, AlOmari T, et al. Comparison of Postoperative Pain After the Utilization of Different File Systems in Single Visit Endodon-tics. Patient Prefer Adherence 2023; 17: 1025–34.

Segura-Egea JJ, Cisneros-Cabello R, Llamas-Carreras JM, Velasco-Ortega E. Pain associated with root canal treatment. Int En-dod J 2009; 42(7): 614–20.

Glennon JP, Ng YL, Setchell DJ, Gulabivala K. Prevalence of and factors affecting postpreparation pain in patients undergoing two-visit root canal treatment. Int Endod J 2004; 37(1): 29–37.

Wu LT, Lin CS, Yang SF. Association between pain, anxiety, and pain relief in patients receiving emergent endodontic treatment. Clin Oral Investig 2022; 26(1): 275–85.

Dou L, Vanschaayk MM, Zhang Y, Fu X, Ji P, Yang D. The prevalence of dental anxiety and its association with pain and other variables among adult patients with irreversible pulpitis. BMC Oral Health 2018; 18(1): 101.

Murillo-Benítez M, Martín-González J, Jiménez-Sánchez MC, Cab-anillas-Balsera D, Velasco-Ortega E, Segura-Egea JJ. Association between dental anxiety and intraoperative pain during root canal treatment: a cross-sectional study. Int Endod J 2020; 53(4): 447–54.

Mittal N, Baranwal HC, Gupta S, Shankari T, Gupta S, Kharat S. Comparative analysis of reduction in pain scores after single visit root canal treatment using endodontic irrigation proto-cols, namely, Conventional needle irrigation, PUI, PIPS and SWEEPS: A randomized control trial. J Conserv Dent 2023; 26(2): 143–9.

Khandelwal A, Jose J, Teja KV, Palanivelu A. Comparative eval-uation of postoperative pain and periapical healing after root canal treatment using three different base endodontic sealers - A randomized control clinical trial. J Clin Exp Dent 2022; 14(2): e144–52.

Eghbal MJ, Haeri A, Shahravan A, Kazemi A, Moazami F, Moza-yeni MA, et al. Postendodontic Pain after Pulpotomy or Root Canal Treatment in Mature Teeth with Carious Pulp Expo-sure: A Multicenter Randomized Controlled Trial. Pain Res Manag 2020; 2020: 5853412.

Stanojević V, Jevtić M, Mitrović M, Panajotović M, Aleksić A, Stano-jević C. Relationship and influences of behavioral and psycho-logical factors on metabolic control of patients with type 2 di-abetes mellitus. Vojnosanit Pregl 2022; 79(12): 1177–85.