TY - JOUR
T1 - Preoperative Factors Associated with Anesthesia Failure for Patients Undergoing Nonsurgical Root Canal Therapy
T2 - A National Dental Practice-Based Research Network Study
AU - The National Dental Practice-Based Research Network Collaborative Group
AU - Weitz, Dustin
AU - Ordinola-Zapata, Ronald
AU - McClanahan, Scott B.
AU - Shyne, Michael
AU - Law, Alan S.
AU - Nixdorf, Donald R.
N1 - Funding Information:
Supported by National Institutes of Health (grant numbers K12-RR023247 , U01-DE016746 , U01-DE016747 , U19-DE-28717 , and UL1TR002494 ).
Publisher Copyright:
© 2021 American Association of Endodontists
PY - 2021/12
Y1 - 2021/12
N2 - Introduction: The aim of this study was to identify preoperative factors associated with local anesthesia failure. Methods: The National Dental Practice-Based Research Network (www.NationalDentalPBRN.org) data from 534 patients who received a nonsurgical root canal treatment completed in a single appointment were included in this analysis. Three methods for defining anesthesia failure were used: definition 1, patient-reported level of numbness; definition 2, provider-reported quality of anesthesia; and definition 3, provider-reported use of supplemental anesthesia. Fifty-one preoperative factors were investigated and analyzed individually against the overall failure rate for each method, and multivariate generalized estimating equation logistic models were fit with predictors chosen using stepwise model selection to evaluate factors that may interact with each other. Results: The overall anesthesia failure rates were 5%, 15%, and 30% for definitions 1, 2, and 3, respectively. Provider experience, diabetes, absence of sharp or aching pain, absence of smoking, and a fair expected outcome were associated with anesthesia failure (definition 1). Provider level of training, absence of a sinus tract, bite sensitivity, and stress making the pain worse were associated with anesthesia failure (definition 2). Provider level of training, pain provoked by stimulus, mandibular teeth, teeth with vital pulps, and pain interfering with daily activities were associated with the use of supplemental anesthesia (definition 3). Conclusions: With the range of 5%–30% of anesthesia failures, a few common factors across the models assessed were elucidated. Providers with higher levels of training had significantly fewer anesthesia failures. Patient self-reported history of diabetes and preoperative pain-related interference with daily activities were associated with more anesthesia failures. Greater severity of various tooth-related pain characteristics, as a group but not individually, accounted for more anesthesia failures.
AB - Introduction: The aim of this study was to identify preoperative factors associated with local anesthesia failure. Methods: The National Dental Practice-Based Research Network (www.NationalDentalPBRN.org) data from 534 patients who received a nonsurgical root canal treatment completed in a single appointment were included in this analysis. Three methods for defining anesthesia failure were used: definition 1, patient-reported level of numbness; definition 2, provider-reported quality of anesthesia; and definition 3, provider-reported use of supplemental anesthesia. Fifty-one preoperative factors were investigated and analyzed individually against the overall failure rate for each method, and multivariate generalized estimating equation logistic models were fit with predictors chosen using stepwise model selection to evaluate factors that may interact with each other. Results: The overall anesthesia failure rates were 5%, 15%, and 30% for definitions 1, 2, and 3, respectively. Provider experience, diabetes, absence of sharp or aching pain, absence of smoking, and a fair expected outcome were associated with anesthesia failure (definition 1). Provider level of training, absence of a sinus tract, bite sensitivity, and stress making the pain worse were associated with anesthesia failure (definition 2). Provider level of training, pain provoked by stimulus, mandibular teeth, teeth with vital pulps, and pain interfering with daily activities were associated with the use of supplemental anesthesia (definition 3). Conclusions: With the range of 5%–30% of anesthesia failures, a few common factors across the models assessed were elucidated. Providers with higher levels of training had significantly fewer anesthesia failures. Patient self-reported history of diabetes and preoperative pain-related interference with daily activities were associated with more anesthesia failures. Greater severity of various tooth-related pain characteristics, as a group but not individually, accounted for more anesthesia failures.
KW - Dental anesthesia
KW - local anesthesia
KW - persistent pain
KW - practice-based research
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U2 - 10.1016/j.joen.2021.09.005
DO - 10.1016/j.joen.2021.09.005
M3 - Article
C2 - 34560117
AN - SCOPUS:85117172299
SN - 0099-2399
VL - 47
SP - 1875
EP - 1882
JO - Journal of Endodontics
JF - Journal of Endodontics
IS - 12
ER -