Reliability of clinical examination methods for postoperative pain after primary root canal treatment

BACKGROUND/PURPOSE: Clinical test results may have lower reliability due to the varying range of test stimulation or patient subjectiveness. This study aimed to verify a reliable clinical test method by comparing pain intensity levels of a tooth at rest, during function, and after the clinical tests of percussion and chewing. MATERIALS AND METHODS: A total of 36 asymptomatic necrotic teeth that required root canal treatment, one in each patient, were included. All treatment procedures were performed in a single visit by an experienced endodontist. Patients were asked to mark their pain levels on a vertical visual analog scale (VAS) while the relevant tooth was at rest and during function 24 h after the treatment. In addition, patients marked their pain levels after the clinical tests of percussion and chewing. Finally, the pain levels were compared using Pearson's correlation for the reliability of the test methods at a significance level of 95%. RESULTS: The postoperative pain levels measured during the clinical tests and functions were significantly higher than the pain levels at rest (P < 0.05). The pain levels after percussion tests were significantly higher than that during the function and chewing tests (P < 0.05). Pain intensity during the function was simulated with a higher correlation when using the chewing strip method rather than the percussion method. CONCLUSION: The bite test using the chewing strips as a pain intensity assessment can mimic the actual postoperative pain experience, whereas the percussion test fails to provide the accuracy of this pain experience.