Pre-operative factors associated with anesthesia failure for patients undergoing non-surgical root canal therapy, a national dental practice-based research network study.

Abstract

INTRODUCTION\nThe aim of this study was to identify preoperative factors associated with local anesthesia failure.\n\n\nMETHODS\nThe National Dental Practice-Based Research Network (www.NationalDentalPBRN.org) data from 534 patients that received a non-surgical 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 pre-operative factors were investigated and analyzed individually against the overall failure rate for each method, and multivariate GEE logistic models were fit with predictors chosen using stepwise model selection to evaluate factors that may interact with each other.\n\n\nRESULTS\nOverall anesthesia failure rates were 5%, 15% and 30% for definitions 1, 2 and 3 respectively. Provider experience, diabetes, absence of sharp or ache pain, absence of smoking, and a fair expected outcome were associated with anesthesia failure (definition 1). Provider level of training, absence of 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).\n\n\nCONCLUSIONS\nWith the range of 5% to 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 was associated with more anesthesia failures. Greater severity of various tooth-related pain characteristics, as a group but not individually, accounted for more anesthesia failures.