Preoperative Pain and Medications Used in Emergency Patients with Irreversible Acute Pulpitis or Acute Apical Periodontitis: A Prospective Comparative Study

Aims: To determine the pain characteristics of and medications used for patients seeking emergency care for irreversible acute pulpitis (IAP) or acute apical periodontitis (AAP). Methods: General (age, sex, weight, general health) and specific (pain intensity, localization, tooth mobility, lymphadenopathy, use of medications) information was noted in 209 patients who appeared for emergency care in 2 dental centers of Dakar with either IAP or AAP. Statistical analysis was performed with the Mann-Whitney and chi-square tests. Results: The sample comprised 97 IAP patients (46.4%) and 112 AAP patients (53.6%); there were no significant differences between the 2 groups with respect to age, sex, or weight. Of the involved teeth, 62% were mandibular and 38% were maxillary. IAP patients waited 6.6 ± 5.3 days before seeking an emergency consultation versus 5.0 ± 3.8 days for AAP patients (P .05). Severe pain was reported in 75% of the IAP and 76% of AAP patients (not significant). Percussion and apical palpation were painful only in AAP, in 98% and 40% of patients, respectively. Mobility and adenopathies were noted only in AAP, in 87% and 46% of patients, respectively (P .001). Seventy-five percent of IAP patients and 80% of AAP patients used medications, mainly non-narcotic analgesics, which offered relief in 62% of IAP patients and 46% of AAP patients. Conclusions: Patients with IAP waited longer than those with AAP before seeking treatment. Self-medication offered better relief in cases of IAP than in cases of AAP. Pain to percussion and palpation, lymphadenopathies, and dental mobility were strong indicators for AAP. Keywords: apical periodontitis, emergencies, medication, pain, pulpitis