Citation Information :
Aoun C, El Osta N, Naaman A, Khalil I. Post-endodontic Flare-ups after a Single-visit Treatment Using the FUI Scoring Method and Associated Factors: A Clinical Prospective Study. J Contemp Dent Pract 2019; 20 (9):1033-1040.
Aim: Flare-ups following a root canal treatment are still a major problem both to the patient and to the clinician. Its definition, etiology, incidence, and risk factors have been the subject of long-standing debate. We conducted this study to investigate the incidence of flare-ups after a single-visit treatment and to identify the factors associated with the flare-up index (FUI).
Materials and methods: All patients treated by postgraduate residents in endodontic specialty at Saint Joseph University of Beirut from June 2018 to January 2019 were invited to participate in the study. After a routine root canal treatment, patients were given a questionnaire to fill after 24 hours–48 hours–7 days, covering a postoperative assessment of symptoms using the visual analogue scale (VAS) and FUI. Patients who experienced a severe postoperative pain and/or swelling were identified and categorized as having a flare-up.
Results: A total of 423 patients (age: 39.76 ± 12.428 years) were included in the study. The incidence of flare-up was 1.9%. The mean FUI was 5.94 ± 5.646 and was highly correlated with the VAS score (p < 0.001). The factors that significantly influenced the occurrence of flare-ups were: pulpal diagnosis (p < 0.001), preoperative drug intake (p < 0.001), preoperative symptoms (>24 hours) before treatment (p < 0.001), and tooth type (p = 0.013).
Conclusion: FUI should be used in further studies to confirm our results since it is a valid quantitative method to assess this clinical phenomenon.
Clinical relevance: Endodontists should take into consideration the diagnosis and the history of preoperative symptoms since it plays an important role in predicting the occurrence of flare-ups and the success of the treatment.
Walton R, Fouad A. Endodontic interappointment flare-ups: a prospective study of incidence and related factors. J Endod 1992 Apr;18(4):172–177. DOI: 10.1016/S0099-2399(06)81413-5.
Sathorn C, Parashos P, et al. The prevalence of postoperative pain and flare-up in single- and multiple-visit endodontic treatment: a systematic review. Int Endod J 2008 Feb;41(2):91–99.
Seltzer S. Pain in endodontics. J Endod 1986 Jan;12(10):505–508. DOI: 10.1016/S0099-2399(86)80207-2.
Alaçam T, Tinaz AC. Interappointment emergencies in teeth with necrotic pulps. J Endod 2002 May;28(5):375–377. DOI: 10.1097/00004770-200205000-00007.
Glennon JP, Ng Y-L, et al. Prevalence of and factors affecting postpreparation pain in patients undergoing two-visit root canal treatment. Int Endod J 2004 Jan;37(1):29–37. DOI: 10.1111/j.1365-2591.2004.00748.x.
Harrison JW, Baumgartner JC, et al. Incidence of pain associated with clinical factors during and after root canal therapy. Part 2 Postobturation pain. J Endod 1983 Oct;9(10):434–438. DOI: 10.1016/S0099-2399(83)80259-3.
Tsesis I, Faivishevsky V, et al. Flare-ups after endodontic treatment: a meta-analysis of literature. J Endod 2008 Oct;34(10):1177–1181. DOI: 10.1016/j.joen.2008.07.016.
Imura N, Zuolo ML. Factors associated with endodontic flare-ups: a prospective study. Int Endod J 1995 Sep;28(5):261–265. DOI: 10.1111/j.1365-2591.1995.tb00311.x.
Morse DR, Koren LZ, et al. Asymptomatic teeth with necrotic pulps and associated periapical radiolucencies: relationship of flare-ups to endodontic instrumentation, antibiotic usage and stress in three separate practices at three different time periods. Int J Psychosom Off Publ Int Psychosom Inst 1986;33(1):5–87.
Seltzer S, Naidorf IJ. Flare-ups in endodontics: I. Etiological factors. 1985. J Endod 2004 Jul;30(7):476–481. DOI: 10.1097/00004770-200407000-00005, ; discussion 475.
Siqueira JF, Rôças IN, et al. Incidence of postoperative pain after intracanal procedures based on an antimicrobial strategy. J Endod 2002 Jun;28(6):457–460. DOI: 10.1097/00004770-200206000- 00010.
Ng Y-L, Glennon JP, et al. Prevalence of and factors affecting post-obturation pain in patients undergoing root canal treatment. Int Endod J 2004 Jun;37(6):381–391. DOI: 10.1111/j.1365-2591.2004. 00820.x.
Albashaireh ZS, Alnegrish AS. Postobturation pain after single- and multiple-visit endodontic therapy. A prospective study. J Dent 1998 Mar;26(3):227–232. DOI: 10.1016/S0300-5712(97)00006-7.
Iqbal M, Kurtz E, et al. Incidence and factors related to flare-ups in a graduate endodontic programme. Int Endod J 2009 Feb;42(2):99–104. DOI: 10.1111/j.1365-2591.2008.01461.x.
Onay EO, Ungor M, et al. The evaluation of endodontic flare-ups and their relationship to various risk factors. BMC Oral Health 2015 Nov 14;15(1):142. DOI: 10.1186/s12903-015-0135-2.
Sun C, Sun J, et al. Pain after root canal treatment with different instruments: A systematic review and meta-analysis. Oral Dis 2018 Sep;24(6):908–919. DOI: 10.1111/odi.12854.
Hou X-M, Su Z, et al. Post endodontic pain following single-visit root canal preparation with rotary vs reciprocating instruments: a meta-analysis of randomized clinical trials. BMC Oral Health 2017 May 25;17(1):86. DOI: 10.1186/s12903-017-0355-8.
Siqueira JF. Microbial causes of endodontic flare-ups. Int Endod J 2003 Jul;36(7):453–463. DOI: 10.1046/j.1365-2591.2003.00671.x.
Rimmer A. The flare-up index: a quantitative method to describe the phenomenon. J Endod 1993 May;19(5):255–256. DOI: 10.1016/S0099-2399(06)81304-X.
AAE. Consensus Conference Recommended Diagnostic Terminology. [Internet]. 2013 [cited 2018 Oct 9]. Available from: https://www.aae.org/specialty/wp-content/uploads/sites/2/2017/07/endodonticdiagnosisfall2013.pdf.
Smith EA, Marshall JG, et al. Nonsteroidal Anti-inflammatory Drugs for Managing Postoperative Endodontic Pain in Patients Who Present with Preoperative Pain: A Systematic Review and Meta-analysis. J Endod 2017 Jan;43(1):7–15. DOI: 10.1016/j.joen.2016.09.010.
Torabinejad M, Cymerman JJ, et al. Effectiveness of various medications on postoperative pain following complete instrumentation. J Endod 1994 Jul;20(7):345–354. DOI: 10.1016/S0099-2399(06)80098-1.
Segura-Egea JJ, Cisneros-Cabello R, et al. Pain associated with root canal treatment. Int Endod J 2009 Jul;42(7):614–620. DOI: 10.1111/j.1365-2591.2009.01562.x.
Trope M. Flare-up rate of single-visit endodontics. Int Endod J 1991 Jan;24(1):24–26. DOI: 10.1111/j.1365-2591.1991.tb00866.x.
Pasqualini D, Corbella S, et al. Postoperative quality of life following single-visit root canal treatment performed by rotary or reciprocating instrumentation: a randomized clinical trial. Int Endod J 2016 Nov;49(11):1030–1039. DOI: 10.1111/iej.12563.
Pak JG, White SN. Pain prevalence and severity before, during, and after root canal treatment: a systematic review. J Endod 2011 Apr;37(4):429–438. DOI: 10.1016/j.joen.2010.12.016.
Torabinejad M, Kettering JD, et al. Factors associated with endodontic interappointment emergencies of teeth with necrotic pulps. J Endod 1988 May;14(5):261–266. DOI: 10.1016/S0099-2399(88)80181-X.
Alves Vde O. Endodontic flare-ups: a prospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010 Nov;110(5):e68–e72. DOI: 10.1016/j.tripleo.2010.05.014.
Attar S, Bowles WR, et al. Evaluation of pretreatment analgesia and endodontic treatment for postoperative endodontic pain. J Endod 2008 Jun;34(6):652–655. DOI: 10.1016/j.joen.2008.02.017.
Polycarpou N, Ng Y-L, et al. Prevalence of persistent pain after endodontic treatment and factors affecting its occurrence in cases with complete radiographic healing. Int Endod J 2005 Mar;38(3):169–178. DOI: 10.1111/j.1365-2591.2004.00923.x.
Saleh N, Awada S, et al. Evaluation of antibiotic prescription in the Lebanese community: a pilot study. Infect Ecol Epidemiol 2015 Jan 1;5(1):27094. DOI: 10.3402/iee.v5.27094.
Mouhieddine TH, Olleik Z, et al. Assessing the Lebanese population for their knowledge, attitudes and practices of antibiotic usage. J Infect Public Health 2015 Jan 1;8(1):20–31. DOI: 10.1016/j.jiph.2014.07.010.
Lindeboom JAH, Frenken JWH, et al. The role of preoperative prophylactic antibiotic administration in periapical endodontic surgery: a randomized, prospective double-blind placebo-controlled study. Int Endod J 2005 Dec;38(12):877–881. DOI: 10.1111/j.1365-2591.2005.01030.x.
American Association of Endodontists position statement: AAE guidance on the use of systemic antibiotics in endodontics. J Endod 2017 Sep;43(9):1409–1413. DOI: 10.1016/j.joen.2017.08.015.
Cope AL, Francis N, et al. Systemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults. Cochrane Database Syst Rev 2018 Sep 27;9:CD010136. DOI: 10.1002/14651858.CD010136.pub3.
Oliveira PS, da Costa KNB, et al. Impact of root canal preparation performed by ProTaper Next or Reciproc on the quality of life of patients: a randomized clinical trial. Int Endod J 2018 Jul;55(2):139–148. DOI: 10.1111/iej.12990.
Chandraweera L, Goh K, et al. A survey of patients’ perceptions about, and their experiences of, root canal treatment. Aust Endod J 2018 Oct;45(2):225–232. DOI: 10.1111/aej.12312.
Philpott R, Gulabivala K, et al. Prevalence, predictive factors and clinical course of persistent pain associated with teeth displaying periapical healing following nonsurgical root canal treatment: a prospective study. Int Endod J 2018 Oct;52(4): 407–415.
Elzaki WM, Ziada HM, et al. Gender and arch effects on the use of non-opioid analgesics for post endodontic pain reduction. Aust Endod J 2017 Oct;44(3):215–224.
Siqueira JF, Rôças IN. Present status and future directions in endodontic microbiology. Endod Top 2014;30(1):3–22.