Endodontik Teşhiste Farklı Ağrı Tanımlayıcılarının, Klinik ve Radyografik Bulguların Birbiri İle İlişkisi

Abstract

Endodontic diagnosis relies on the interpretation of clinical testing, radiographic imaging and patient reported pain description in order to assess pulpal and periapical infection and inflammation. The relationship between clinical and radiographic information and patient reported pain description is largely unknown. The aim of this study is to evaluate the interrelationship of clinical, radiographic findings and patient reported pain description in endodontic diagnosis. 228 patients referred to endodontic emergency, with odontogenic pain complaint were included in the study. Their clinical testing (cold test, EPT, percussion, palpation, bite test) and radiographic examinations were performed by calibrated endodontic examiners. 20 different pain descriptors and their intensity with VAS scale were obtained verbally. In order to analyze the data, two-way ANOVA and chi-square tests were performed. No significant interaction effects were identified (p<0.05). Patients experiencing toothache with hypersensitivity to percussion reported higher levels of current pain, worst pain, pain at rest, pain at function, radiating and throbbing pain, as well as pain when chewing, or with exposure to cold, than those normally sensitive to percussion (all p<0.05). By contrast, patients experiencing toothache from a tooth with a vital pulpal status reported higher levels of shooting pain (p<0.05). Frequency of pain medication use, presence of radiolucency and positive bite test results were significantly different among groups (p<0.05). Current pain, worst pain, pain at rest, pain at function, radiating, throbbing, and evoked pain are associated with percussion sensitivity could point out that development of percussion sensitivity may increase patient’s pain experience and could reflect central sensitization or more advanced inflammatory processes. Shooting pain is more prominent in odontalgia patients with a vital pulp diagnosis, and may be a unique feature of pulp mediated pain and may reflect neuropathic pain characteristics. Detailed pain history may ameliorate endodontic diagnosis. Also, the relationship between vitality and percussion with detailed pain history, clinical and radiographic findings may distinguish the underlying biological pain mechanisms in different stages of the disease.