75% of patients reported no pain during routine dental treatment

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Despite  improvements in dental practice dental procedures are often perceived as painful and uncomfortable.  The aim of the study was to investigate factors that influence pain intensities associated with routine dental procedures.

This study was conducted in general dental practices in the North West of England. 451 dental patients self-reported pain experienced during the procedure immediately after undergoing a variety of common dental interventions and 1 day after the completion of the procedure. Pain character was measured using the McGill short-form pain questionnaire and intensity using a numerical rating (NRS) scale. Information was collected on a number of factors that could influence pain: dental anxiety was measured using the Corah Dental Anxiety Scale to categorize patients into four domains (fearless, some unease, nervous and very anxious). Dentists provided information regarding the type(s) of procedure and use of local anaesthetic (LA).

They found

  • The majority of patients (81.9%) only underwent one procedure.
  • 75%  percent of patients (339/451) reported no pain during their procedure.
  • Dental anxiety, LA use and type of procedure (extractions) were significant predictors of reported intra-operative pain.
  • In a multivariate model, the strongest predictor of pain was
    • dental anxiety [odds ratio (OR) = 4.98 (95% CI 1.42-17.44)] and
    • LA use [OR = 2.79 (95% CI 1.39-5.61)].
  • The strongest predictor of postoperative pain on the next day was
    • pain reported during the procedure [OR = 5.85 (95% CI 2.71-12.64)],
    • LA use [OR = 3.16 (95% CI 1.02-9.81)].

The authors concluded

Dentists need to assess their patients both preoperatively for dental anxiety and intra-operatively for signs of suboptimal local anaesthesia so as to effectively align patient management and clinical techniques to control dental anxiety and produce adequate anaesthesia.

Tickle M, Milsom K, Crawford FI, Aggarwal VR. Predictors of pain associated with routine procedures performed in general dental practice. Community Dent Oral Epidemiol. 2012 Feb 8. doi: 10.1111/j.1600-0528.2012.00673.x. [Epub ahead of print] PubMed PMID: 22316006.

 

 

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Derek Richards

Derek Richards is the Director of the Centre for Evidence-based Dentistry, Editor of the Evidence-based Dentistry Journal, Consultant in Dental Public Health with Forth Valley Health Board and Honorary Senior Lecturer at Dundee & Glasgow Dental Schools. He helped to establish both the Centre for Evidence-based Dentistry and the Evidence-based Dentistry Journal. He has been involved with teaching EBD and a wide range of evidence-based initiatives both nationally and internationally since 1994.

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