Factors associated with painful apical periodontitis

Abstract

Aim: To identify and describe the socioeconomic status, dental anxiety, and tooth specific factors associated with symptomatic apical periodontitis in patients who attended and received treatment at the University of Otago School of Dentistry.

Methodology: The study was comprised of two parts. The first part consists of a consecutive sample of 102 patients who were seen at the Urgent Care Unit at the School of Dentistry. All patients presented with clinical signs and symptoms of acute apical periodontitis. The mean age of this group was 34.9 years. Tooth specific risk factors such as the type of tooth, caries experience, periodontal condition, tooth mobility, and type of intracoronal or extracoronal restoration were collected by clinical examination. Socioeconomic variables, dental anxiety, and regularity of dental care information were collected by means of a questionnaire. Periapical radiographs of the affected tooth and posterior bitewing radiographs were examined. The second part of the study included 150 randomly selected files of patients who had been treated for persistent apical periodontitis with acute symptoms. The clinical information and radiographs were used to assess the quality of a restoration and coronal seal and quality of a root filling. The mean age of this group was 46.7 years. Statistical calculations were made with a computerised statistical package (SPSS).

Results: The presence of carious lesions was significantly associated with primary acute apical periodontitis and incorrect root filling lengths were significantly associated with refractory apical periodontitis. The other statistically significant findings were the association between the presence of refractory apical periodontitis and teeth restored with prefabricated posts and molar teeth significantly more represented in primary and secondary apical periodontitis than any other tooth type. There was no association between apical periodontitis and alveolar crestal bone loss, socioeconomic status of an individual, dental visit type, and dental anxiety.

Conclusion: Within the limitations of the study the most reliable indicators of apical periodontitis are primary carious lesions, radiographic evidence of incorrect root filling length, and a cast post with coronal restoration.