Endodontic Infections and Pain

This chapter reviews the pain system and its interaction with microbial and inflammatory factors and uses this knowledge base to make evidence-based recommendations for managing endodontic-related pain. The management of the patient with pain resulting from an odontogenic infection involves both pharmacologic and non-pharmacologic therapies. Appropriate pharmacotherapy includes drugs that reduce pain perception or microbial infection. Pain perception can be reduced by the administration of local anesthetics or the use of analgesics. Moreover, elevated lipopolysaccharides (LPS) concentrations in infected root canal systems have been positively correlated with painful presentations of peri-radicular periodontitis. The direct sensitization of nociceptors by LPS may explain why some immunocompromised patients present with devastatingly painful infections. Historically, many patients harbor a negative association between dentistry and pain. Moreover, clinicians often face the challenge of managing pain and suffering that occurs in their patients.