Main points
- Similar initial pain levels: Studies have found that women with and without anemia experience similar levels of pain within 24 hours of root canal surgery.
- Non-anemic patients experienced significant pain relief: Patients without anemia experienced significant pain relief within 48 hours and 72 hours after surgery, suggesting that anemia is associated with continued pain in the days following surgery.
- Anemia as a risk factor: Anemia has been identified as a risk factor for retroendodontic pain, emphasizing the importance of diagnosing and treating anemia to improve the quality of patient care.
- High prevalence of retropulpal pain: The study showed a high prevalence of retropulpal pain (80%) in both anemic and non-anemic groups, with the prevalence gradually decreasing over time to 7 reached its lowest level within days.
- Effect of Pulp Condition: Pulp condition (viability and necrosis) of mandibular premolars and molars significantly affects pain levels before and after treatment, with patients reporting greater pain in necrotic teeth 24 hours later.
Results of a new study assessing pain after root canal surgery show that women with and without anemia had similar levels of pain within 24 hours of surgery, but women without anemia had greater pain relief after 48 hours and 72 hours. big.
Anemia is a risk factor for post-endodontic pain, so the study’s researchers emphasize that diagnosing and treating anemia can improve the quality of patient care. Previous studies have examined the association between anemia and post-treatment pain; for example, one early study found that patients with pathological anemia experienced severe pain during periods of blood vessel obstruction. 2
This new descriptive cross-sectional study wished to examine the relationship between iron deficiency anemia and pain severity after root canal treatment. Specifically, the team wanted to examine pain levels in women with and without iron deficiency anemia. 1
Led by Maryam Kazemipoor, MS, PhD, Department of Endodontics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran, researchers collected a sample of participants (n = 60) aged 18 to 54 years. Participants had previously been treated at a specialized clinic in Yazard and had been diagnosed with reversible pulpitis with or without acute apical periodontitis, pulp necrosis with acute apical periodontitis, and pulp necrosis with lower posterior teeth. Acute periapical abscess.
“Surprisingly, the incidence of post-endodontic pain associated with iron deficiency anemia has not been studied to date,” the researchers wrote. “The primary purpose of this study was to evaluate patients with and without root canal treatment. Prevalence and intensity of pain in patients with iron deficiency anemia.”
Half of the women had hemoglobin levels above 13 (indicating no iron deficiency anemia), and the other half had hemoglobin levels below 11 (indicating iron deficiency anemia). The average hemoglobin level for the entire study group ranged from 7.70 to 14.90.
The researchers also examined tooth type. 16.9% had mandibular first premolars, 27.1% had mandibular second premolars, 35.6% had mandibular first molars, and 20.3% had mandibular second molars. As for the pupal state, 36.7% had necrotic teeth and 63.3% had irreversible pulpitis. Regarding periapical status, 41.7% of patients had acute periapical periodontitis, 1.7% had acute periapical abscess, and 56.7% of patients had normal periapical status.
All patients underwent root canal treatment. Thereafter, the patient took 400 mg of ibuprofen every 8 hours. The researchers recorded pain levels 24, 48 and 72 hours later. Then, they analyzed the data using SPSS software, two-way ANOVA, paired t-test, and Pearson correlation coefficient.
The researchers found that the incidence of pain was 80% in both the anemic and non-anemic groups. For people with only iron-deficiency anemia, the figure was 71.66%, and for people without iron-deficiency anemia, the figure was 61.12%.
The 24-hour pain incidence rate in anemic patients was 100%, the 48-hour pain incidence rate was 96.67%, and the 72-hour pain incidence rate was 50%. At the same time, the 24-hour pain incidence rate of patients without anemia was 100%, the 48-hour pain incidence rate was 53.34%, and the 72-hour pain incidence rate was 40%. Therefore, patients with anemia experience more severe pain 2-3 days later than patients without anemia.
“The results showed that the prevalence of pulpal pain was high before treatment (28%), but decreased moderately within 1 day (24%) and reached a minimum level by 7 days (14%),” the team wrote. “Additionally , the severity of pulpal pain after treatment was moderate, but decreased within 1 day after treatment and reached its lowest level within 7 days.”
After t-test, there was no significant difference in preoperative pain (ask = .643) and 24-hour postoperative pain (ask =.093).
Still, when comparing anemic and non-anemic patients, the team noted a significant difference in pain 48 hours after surgery (ask = .004) and 72 hours (ask =.034).
For patients without anemia, the mean difference (-0.73) between increased pain before and 24 hours after treatment was not statistically significant (ask =.118). Although there was a statistically significant difference in the iron deficiency anemia group (ask =.007).
The researchers found a statistically significant mean difference in pain relief before treatment and after 48 hours (ask =.003). For the anemia group, there was no significant difference in pain before treatment and after 48 hours (ask =.163).
Finally, there was a statistical mean difference in pain relief in the non-anemic group over 72 hours before treatment and after 3 days of treatment (ask =.000). For the anemia group, the mean difference in pain before treatment and after 72 hours was significant (ask =.000).
Age ultimately had no effect on average pain, nor did tooth type, as no significant differences were found.
The researchers found that the pulpal condition (vitality and necrosis) of the mandibular premolars and molars had a significant impact on the mean difference in pain before and after treatment.
Patients reported more severe pain in necrotic teeth 24 hours later than in patients with irreversible pulpitis. When pain was assessed 48 hours and 72 hours after surgery, patients reported less pain in teeth with both necrotizing pulpitis and irreversible pulpitis, but more pain relief in teeth with irreversible pulpitis.
“In this study, we observed that anemic women had higher mean pain intensity before and after treatment compared with non-anemic women, with significant differences emerging after 48 and 72 hours,” the team wrote. However, while the mean pain score after 72 (hours) may show statistical significance between anemic and non-anemic patients, it may not be clinically meaningful.”
refer to
- Kazemipoor, M., Moradi, H., Mokhtari, F., & Kheirollahi, K. (2023). To assess the occurrence and severity of pre- and post-endodontic pain in anemic and healthy female patients. Clinical and Experimental Dental Research, 1-7. https://doi.org/10.1002/cre2.799
- Kawar, N., Alrayyes, S., & Aljewari, H. (2018). Sickle cell disease: Overview of orofacial and dental manifestations. Monthly Disease, 64(6), 290–295.