

































   
( ISSN: 2814-2098 )                                                                                               Andrianjafinoro Tsiriniaina Hasinjanahary1* 

http://ijojournals.com/ Volume 06 Issue 12 || Dec., 2023 || 

PSYCHOLOGICAL IMPACT OF POST-OPERATIVE ENDODONTIC PAIN 

 

 

 

 

PSYCHOLOGICAL IMPACT OF POST-OPERATIVE ENDODONTIC 

PAIN 

 

Authors: Andrianjafinoro Tsiriniaina Hasinjanahary1, Randriamalala Njarasoa Charlette1, 

Lalanirina Gaël Lauricia1, Rakotonirina Faliniaina Paul1, Rafalimino Holy Nasandratra1 

,Randriamboavonjy Aldy Victoria Pasca2, Rakoto Alson Simone3 ,Ramaroson Juvence3 

1 : Formerinterne in Odontostomatology, Institute of Tropical Odonto-Stomatology of 

Madagascar, Universityof Mahajanga Madagascar 

2 : Doctor of dental surgery IOSTM Mahajanga BP 98 

3 : Full Professor in Odontostomatology, Institute of Tropical Odontostomatology of Madagascar, 

University of Mahajanga Madagascar 

 

Abstract  
Post-operative pain is defined as the onset or worsening of a painful symptomatology 

related to the therapeutic procedure and/or the pathological condition that justified the 

procedure. Various types of post-endodontic pain have been observed, ranging from 

inflammatory to chronic. The aim of the present study was to determine the extent of the 

psychological impact of post-endodontic pain. 

The study was carried out in the city of Majunga, at the Centre de Soins et de Traitements 

Dentaires of the Institut Odonto-Stomatologie Tropicale Madagascar. It was a prospective, 

descriptive, cross-sectional study conducted from March to June 2023.Fifty patients aged 18 and 

over with post-endodontic pain were recruited to the study.A questionnaire in the form of an 

interview was carried out to collect the data, which were entered, processed and analyzed on 

computer using SPSS 20.0 software. 

The results highlighted that the characteristics of postoperative pain in endodontics vary 

according to type, intensity, onset and even evolution. Pain has a psychological impact on the 

patient's life, causing apprehension about pain (92%), fear of dentists (6%) and dental anxiety 

(12%).  

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
( ISSN: 2814-2098 )                                                                                               Andrianjafinoro Tsiriniaina Hasinjanahary1* 

http://ijojournals.com/ Volume 06 Issue 12 || Dec., 2023 || 

PSYCHOLOGICAL IMPACT OF POST-OPERATIVE ENDODONTIC PAIN 

 

 

 

 

The management of post-operative pain and its impact on patient psychology should not 

be underestimated. 

 Thus, an analytical study with representative samples would be desirable to fully 

understand this pathology, which presents a real public health problem. 

Key words: Inflammatory flare-up, Endodontic treatment, Postoperative pain, Psychology 

Introduction  

Postoperative pain is defined as the onset or worsening of a painful symptomatology 

related to the therapeutic procedure and/or the pathological condition that justified the 

procedure. 

It may be of immediate or delayed onset, and may be transient, prolonged or permanent. 

On the basis of its temporal definition, we can speak of postoperative inflammatory pain when it 

lasts less than 7 days, and of chronic pain when it lasts more than 3 months. [1] 

Varying in intensity from patient to another, its clinical features are very often similar to 

those of acute apical periodontitis: they translate into continuous pain, exacerbated by occlusal 

percussion or periapical palpation and is often well localized by the patient. [2] 

In 2011, the results of a systematic review and meta-analysis by Pak andal showed that 

the prevalence of post-operative pain averaged 40% 24 hours after treatment and 11% at 7 days 

[1]. 

In 2013, a prospective clinical study based on 374 root canal treatments reported a high 

incidence of pain of 47,3%, of which 69,5% occurred during the first two post-operative days [3]. 

The experience of pain is likely to leave a negative memory that can engender fear. This 

fear, experienced during treatment, encourages a hyperfocusing of attention on the treated area, 

and can amplify the painful experience. Thus, pain can generate anxiety, but anxiety can also 

amplify, or even generate, pain, hence the psychological impact on a patient [4] [6]. 

Following a survey, Larrea L et al asserted that fear of pain is one of the main barriers to 

access to care, and thus contributes to the poor oral and dental health of part of the population: 4 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
( ISSN: 2814-2098 )                                                                                               Andrianjafinoro Tsiriniaina Hasinjanahary1* 

http://ijojournals.com/ Volume 06 Issue 12 || Dec., 2023 || 

PSYCHOLOGICAL IMPACT OF POST-OPERATIVE ENDODONTIC PAIN 

 

 

 

 

to 20% of French people suffer from dental anxiety, including 6% for whom the phobia represents 

a total obstacle to care. [6] 

As a result, postoperative pain in endodontics may have a negative impact on treatment, 

by reducing patient compliance and confidence in the odontostomatologist; it also affects daily 

life, sleep quality and quality of life, and may reduce the patient's ability to work. 

It can also have psychological repercussions, including a permanent focus on pain. [7] 

In Madagascar, few studies of post-operative pain in endodontics have been conducted. To 

contribute to this, this study was carried out on Malagasy patients to answer the following 

research question: does post-endodontic treatment pain have psychological effects on the 

patient? 

The aims of the study were to identify the characteristics of post-operative pain in 

endodontics, and to determine the extent of the psychological impact of post-operative pain in 

endodontics. 

Materials and Methods 

This was a prospective, descriptive, cross-sectional study conducted over a three-month 

period from March 2023 to June 2023 at the Dental Care and Treatment Center (CSTD) of the 

Institut Odonto-Stomatologie Tropicale Madagascar (IOSTM) in Majunga. The study population 

consisted of 50 patients presenting to the CSTD for pain after endodontic treatment or 

retreatment during this period. Patients aged 18 and over presenting with post-endodontic pain 

were included in the study. 

Mentally handicapped and uncooperative patients were excluded from the study. 

The following items and information were recorded: 

 Social characteristics (gender, age) 

 Tooth types (monoradiculated, pluriradiculated) 

 Initial dental pathology (pulpitis, pulpal necrosis, apical periodontitis) 

 Types of treatment (initial endodontic treatment, endodontic retreatment)  

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
( ISSN: 2814-2098 )                                                                                               Andrianjafinoro Tsiriniaina Hasinjanahary1* 

http://ijojournals.com/ Volume 06 Issue 12 || Dec., 2023 || 

PSYCHOLOGICAL IMPACT OF POST-OPERATIVE ENDODONTIC PAIN 

 

 

 

 

 Pain characteristics (location, intensity, description of pain, period of onset, 

frequency of onset in 24 hours, onset of pain, factors affecting pain, signs associated 

with pain, course of pain) 

 Use of pain-relieving medication 

 Psychological impact of pain (apprehension of pain, fear, anxiety) 

Evaluation criteria: 

-for pain : 

  Visual Analogue Scale (VAS) 

This is the scale used to define the intensity of the subject's pain. 

-for anxiety: 

 The "CDAS" scale (Corah Dental AnxietyScale) is used to assess the patient's 

anxiety about dental treatment [8] 

A pre-established, tested and validated anonymous questionnaire has been designed to 

collect information. 

A request for authorization from CSTD's clinical teaching staff was made before the start of the 

study, and information was collected in the form of individual interviews. Free and informed 

consent was obtained from the patients interviewed, after the objectives of the study had been 

clearly explained to them, and confidentiality was respected. 

Data were analyzed using SPPSS 20.0 software.Then, the association between the existence of 

post-endodontic pain and social characteristics, pain characteristics and the psychological impact 

of pain was carried out using the Chi-square test. The results were considered significant at 

p<0.05 if the test conditions were respected. 

 

 

 

 

 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
( ISSN: 2814-2098 )                                                                                               Andrianjafinoro Tsiriniaina Hasinjanahary1* 

http://ijojournals.com/ Volume 06 Issue 12 || Dec., 2023 || 

PSYCHOLOGICAL IMPACT OF POST-OPERATIVE ENDODONTIC PAIN 

 

 

 

 

Results 

Table I: Social characteristics of the sample 

Social characteristics Effective (n) Proportion (%) 

Gender    

 Male 21 42 

 Feminine 29 58 

 Total 50 100 

Age (in 

years) 
   

 18 to 24 19 38 

 25 to 34 11 22 

 35 to 44 11 22 

 45 to 54 5 10 

 ≥ 55  4 8 

 Total 50 100 

 

 

 

 

 

 

 

 

 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
( ISSN: 2814-2098 )                                                                                               Andrianjafinoro Tsiriniaina Hasinjanahary1* 

http://ijojournals.com/ Volume 06 Issue 12 || Dec., 2023 || 

PSYCHOLOGICAL IMPACT OF POST-OPERATIVE ENDODONTIC PAIN 

 

 

 

 

Table I: Distribution of the sample according to the history of the treated tooth 

Treated tooth 
Effective 

(n) 
Proportion (%) 

Type of 

treatment 
   

 Initial 

endodontic 

treatment 

32 64.0 

 Endodontic 

retreatment 
18 36.0 

 Total 50 100 

Type of tooth     

 Monorooted 20 40.0 

 Multirooted 30 60.0 

 Total 50 100 

Initial dental 

pathology 
   

 Pulpitis 24 48.0 

 
Necrosis 11 22.0 

 Apical 

periodont

itis 

15 30.0 

 Total 50 100 

 

 

 

 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
( ISSN: 2814-2098 )                                                                                               Andrianjafinoro Tsiriniaina Hasinjanahary1* 

http://ijojournals.com/ Volume 06 Issue 12 || Dec., 2023 || 

PSYCHOLOGICAL IMPACT OF POST-OPERATIVE ENDODONTIC PAIN 

 

 

 

 

 

Table II: Distribution of the sample according to the characteristics of post-endodontic pain 

 

Pain characteristics 
Effective 

(n) 

Proportion 

(%) 

Location    

 Localized 33 66.0 

 Diffuse 17 34.0 

 Total 50 100 

Intensity    

 2 to 4 (light) 10 20.0 

 5 to 7 (moderate) 26 52.0 

 8 to 10 (severe) 14 28.0 

 Total 50 100 

Frequency of 

pain occurrence 

 
  

 Between 1 and 5 times 35 70.0 

 Between 6 and 10 times 14 28.0 

 11 times and more 1 2.0 

 Total 50 100 

 

 

 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
( ISSN: 2814-2098 )                                                                                               Andrianjafinoro Tsiriniaina Hasinjanahary1* 

http://ijojournals.com/ Volume 06 Issue 12 || Dec., 2023 || 

PSYCHOLOGICAL IMPACT OF POST-OPERATIVE ENDODONTIC PAIN 

 

 

 

 

 

Pain characteristics 
Effective 

(n) 

Proportion 

(%) 

Types of pain    

 Shock 06 3.92 

 compression 14 9.15 

 Stab 05 3.26 

 Pain caused 14 9.15 

 Painful cold feeling 06 3.92 

 Sharp pain 10 6.53 

 Shooting pain 06 3.92 

 Radiating pain 25 16.33 

 Throbbing pain 27 17.64 

 Persistent pain 36 23.52 

 Sensitivity at the gum  04 2.61 

 Total 153 100 

    

 

 

 

 

 

 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
( ISSN: 2814-2098 )                                                                                               Andrianjafinoro Tsiriniaina Hasinjanahary1* 

http://ijojournals.com/ Volume 06 Issue 12 || Dec., 2023 || 

PSYCHOLOGICAL IMPACT OF POST-OPERATIVE ENDODONTIC PAIN 

 

 

 

 

 

 

Pain characteristic 
Effective 

(n) 

Proportion 

(%) 

Period of 

Onset of Pain 
   

 Immediately after 

treatment 
10 20.0 

 
Later in the day 2 4.0 

 
The day after 19 38.0 

 48 hours after 

treatment 
10 20.0 

 
More than 2 days 9 18.0 

 
Total 50 100 

 

 

 

 

 

 

 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
( ISSN: 2814-2098 )                                                                                               Andrianjafinoro Tsiriniaina Hasinjanahary1* 

http://ijojournals.com/ Volume 06 Issue 12 || Dec., 2023 || 

PSYCHOLOGICAL IMPACT OF POST-OPERATIVE ENDODONTIC PAIN 

 

 

 

 

 

 

Pain characteristic 
Effective 

(n) 

Proportion 

(%) 

Evolution of 

pain 
   

 
gradually 

diminished 
23 46.0 

 

Very weak now 6 12.0 

 accentuated daily 

7 14.0 

  

completely 

disappeared 

 

7 

 

14.0 

 Variable and 

episodic 4 8.0 

  

don't remember 

anymore 

3 6.0 

 Total 50 100 

 

 

 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
( ISSN: 2814-2098 )                                                                                               Andrianjafinoro Tsiriniaina Hasinjanahary1* 

http://ijojournals.com/ Volume 06 Issue 12 || Dec., 2023 || 

PSYCHOLOGICAL IMPACT OF POST-OPERATIVE ENDODONTIC PAIN 

 

 

 

 

Table III: Distribution of the sample according to the possibility of taking medication 

 

Medicines 
Effective 

(n) 
Proportion (%) 

Taking 

medication 
   

 Yes 33 66.0 

 No 17 34.0 

 Total 50 100 

Type of 

medications 
   

 Analgesic 17 34.0 

 Analgesic + 

antibiotic 
9 18.0 

 Analgesic + 

NSAIDs 
1 2.0 

 Analgesic + ATB 

+ NSAIDs 
1 2.0 

 Antibiotic 5 10.0 

 None 17 34.0 

 Total 50 100 

ATB: antibiotic 

NSAID: Non-steroidal anti-inflammatory 

 

 

 

 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
( ISSN: 2814-2098 )                                                                                               Andrianjafinoro Tsiriniaina Hasinjanahary1* 

http://ijojournals.com/ Volume 06 Issue 12 || Dec., 2023 || 

PSYCHOLOGICAL IMPACT OF POST-OPERATIVE ENDODONTIC PAIN 

 

 

 

 

 

Table V: Distribution of the sample according to the psychological impact of post-endodontic pain 

Psychological impact 
Effective 

(n) 
Proportion (%) 

Pain 

apprehension 

 
  

Yes  46 92 

No  4 8 

Fear of 

dentists 

 
  

Yes  
3 6 

No  47 94 

Anxiety    

Yes  6 12 

No  44 88 

Total  
50 100 

 

 

 

 

 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
( ISSN: 2814-2098 )                                                                                               Andrianjafinoro Tsiriniaina Hasinjanahary1* 

http://ijojournals.com/ Volume 06 Issue 12 || Dec., 2023 || 

PSYCHOLOGICAL IMPACT OF POST-OPERATIVE ENDODONTIC PAIN 

 

 

 

 

Table VI: Distribution of the sample according to social characteristics and apprehension of pain 

 

Social characteristics Apprehension of pain 

Yes  

   (n)          

(%) 

No 

(n)      (%)           

Total  

(n)       (%) 

Gender      

Male 

 

         14      66,7 7 33,3     21 100 

Féminine 

 

25 86,2 4 13,8     29 100 

Total  39     78,0     11 22,0    50 100 

Age (in years)       

18 to 24       16     84,2      3     15,8    19 100 

25 to 34        8     72,7      3      27,3    11 100 

35 to 44       8     72,7      3      27,3    11 100 

45 to 54        4     80,0      1     20,0     5 100 

≥ 55        3     75,0      1     25,0     4 100 

Total       39    78,0     11     22,0     50 100 

 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
( ISSN: 2814-2098 )                                                                                               Andrianjafinoro Tsiriniaina Hasinjanahary1* 

http://ijojournals.com/ Volume 06 Issue 12 || Dec., 2023 || 

PSYCHOLOGICAL IMPACT OF POST-OPERATIVE ENDODONTIC PAIN 

 

 

 

 

 

Table VII: Distribution of the sample according to pain intensity and pain apprehension 

 

Pain intensity Pain apprehension 

Yes 

(n) (%) 

No 

(n) (%) 

Total 

(n) (%) 

Intensity       

2 – 4 (light) 9 90.0 1 10.0 10 100 

5 – 7 (moderate) 19 73.07 7 26.93 26 100 

8 -10 (severe) 11 78.6 3 21.4 14 100 

Total 39 78.0 11 22.0 50 100 

 

 

 

 

 

 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
( ISSN: 2814-2098 )                                                                                               Andrianjafinoro Tsiriniaina Hasinjanahary1* 

http://ijojournals.com/ Volume 06 Issue 12 || Dec., 2023 || 

PSYCHOLOGICAL IMPACT OF POST-OPERATIVE ENDODONTIC PAIN 

 

 

 

 

 

Table VIII: Distribution of the sample according to social characteristics and fear of dentists 

Social characteristics Fear of dentists 

Yes 

   (n)          

(%) 

No 

(n)      (%)           

Total  

(n)       (%) 

Gender      

Male 

 

          5      23,8    16 76,2     21 100 

Feminine 

 

3 10,3 26 89,7     29 100 

Total  8     16,0     42 84,0    50 100 

Age (in years)       

18 to 24       1      5,3      18     94,7    19 100 

25 to 34       5     45,5       6      54,5    11 100 

35 to 44      1      9,1      10      90,9    11 100 

45 to 54      0     00,0       5     

100,0 

     5 100 

  ≥ 55       1     25,0       3     75,0      4 100 

Total       8     16,0     42     84,0     50 100 

 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
( ISSN: 2814-2098 )                                                                                               Andrianjafinoro Tsiriniaina Hasinjanahary1* 

http://ijojournals.com/ Volume 06 Issue 12 || Dec., 2023 || 

PSYCHOLOGICAL IMPACT OF POST-OPERATIVE ENDODONTIC PAIN 

 

 

 

 

 

Table IX: Distribution of the sample according to pain intensity and fear of dentists 

 

Pain intensity Fear of dentists 

Yes 

(n) (%) 

No 

(n) (%) 

Total 

(n) (%) 

Intensity       

2 - 4 (light) 2 20.0 8 80.0 10 100 

5 - 7 (moderate) 5 19.24 21 80.76 26 100 

8 – 10 (severe) 1 7.15 13 92.85 14 100 

Total 8 16.0 42 84.0 50 100 

 

 

 

 

 

 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
( ISSN: 2814-2098 )                                                                                               Andrianjafinoro Tsiriniaina Hasinjanahary1* 

http://ijojournals.com/ Volume 06 Issue 12 || Dec., 2023 || 

PSYCHOLOGICAL IMPACT OF POST-OPERATIVE ENDODONTIC PAIN 

 

 

 

 

 

Table X: Distribution of the sample according to social characteristics and dental anxiety 

Social characteristics Dental anxiety 

Yes 

   (n)          

(%) 

No 

(n)      (%)           

Total  

(n)       (%) 

Gender      

Male 

 

          4      19,0     17 81,0     21 100 

Feminine 

 

5 17,2 24 82,8     29 100 

Total  9     18,0     41 82,0     50 100 

Age (in years)       

18 to 24      3     15,8      16     84,2    19 100 

25 to 34       2     18,2      9      81,8    11 100 

35 to 44      1     9,1      10      90,9    11 100 

45 to 54       3     60,0      2     40,0      5 100 

 ≥ 55       0     00,0      4     

100,0 

     4 100 

Total       8    16,0     42     82,0     50 100 

 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
( ISSN: 2814-2098 )                                                                                               Andrianjafinoro Tsiriniaina Hasinjanahary1* 

http://ijojournals.com/ Volume 06 Issue 12 || Dec., 2023 || 

PSYCHOLOGICAL IMPACT OF POST-OPERATIVE ENDODONTIC PAIN 

 

 

 

 

 

Table XI: Distribution of the sample according to pain intensity and dental anxiety 

Pain intensity Dental anxiety 

Yes 

(n) (%) 

No 

(n) (%) 

Total 

(n) (%) 

Intensity       

2 – 4 (light) 0 00.0 10 100.0 10 100 

5 – 7 (moderate) 6 23.08 20 76.92 26 100 

8 -10 (severe) 3 21.4 11 78.6 14 100 

Total 9 18.0 41 82.0 50 100 

 

Discussion 

Social characteristics 

Among the sample studied, the female gender predominates at 58% with a sex ratio of 0.72 

(Table I). According to Akram andal in 2016, there is a similarity of results demonstrating the 

predominance of females in patients with post-endodontic pain. [36] Similarly, some studies 

have shown a higher prevalence of postoperative pain in women than in men (Walton, 2002). [9] 

Several explanations have been put forward: 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
( ISSN: 2814-2098 )                                                                                               Andrianjafinoro Tsiriniaina Hasinjanahary1* 

http://ijojournals.com/ Volume 06 Issue 12 || Dec., 2023 || 

PSYCHOLOGICAL IMPACT OF POST-OPERATIVE ENDODONTIC PAIN 

 

 

 

 

- the pain tolerance threshold is higher in men (Gotler andal, 2012) [10]. 

- women suffer more psychosomatic illnesses and their pain is governed by emotional factors (Ng 

andal, 2004)[11]. 

This could be explained by differences in the physiological response to pain, and by the fact that 

women present biological particularities that influence pain (hormonal fluctuation, contraceptive 

treatment) (Gufran and al, 2012)[12]. 

According to age, the 18-24 age group was the most affected, at 38% (Table I).2014 study by 

Sipaviciute and Manelien corroborates these results, explaining that older patients present less 

post-operative pain due to the reduced diameter of the root canal, allowing less debris to pass 

beyond the apex [13]. 

However, other authors conclude that there would be more pain in the elderly due to a decrease 

in the volume of the endodontic system, thinning of the dental canal making treatment more 

difficult and therefore increasing the risk of pain (Arias andal, 2013)[14], less blood flow and 

delayed healing[11]. 

History of the treated tooth 

Regarding the type of treatment (Table II), 64% of teeth treated with initial endodontic therapy 

showed more post-operative pain, compared with 36% of teeth treated with endodontic 

retreatment. This result corroborates the study by Gotler et al, who reported significantly higher 

post-operative pain after initial treatment than after endodontic retreatment [10]. In contrast, 

other studies found that patients undergoing endodontic retreatment were clearly at greater risk 

of suffering an inflammatory outbreak[15]. Whether initial treatment or retreatment, the main 

cause of postoperative pain may be due to incomplete mechanochemical preparation of the apical 

part of the root canal. 

In terms of initial dental pathologies (Table II), the proportion of teeth with pulpitis is high at 

48%, followed by apical periodontitis (30%), and pulpal necrosis (22%).The correlation between 

postoperative pain and pulpal status (vital or necrotic tooth), is complex and still remains 

controversial where some reports have identified a significant relationship between these two 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
( ISSN: 2814-2098 )                                                                                               Andrianjafinoro Tsiriniaina Hasinjanahary1* 

http://ijojournals.com/ Volume 06 Issue 12 || Dec., 2023 || 

PSYCHOLOGICAL IMPACT OF POST-OPERATIVE ENDODONTIC PAIN 

 

 

 

 

factors(Segura-Egea andal,2009[16],Gotler andal., 2012)[10], others not (Pasqualini andal, 

2012)[17]; (Sevekar and Gowda, 2017)[18]. 

However, one study has shown that teeth with a periapical lesionare considered a risk factor for 

postoperative pain, and the risk of pain onset is 9.64 times greaterwhen a lesion is present prior 

to the practitioner's intervention [13].  

Depending on the type of tooth (Table II), there is a higher incidence of postoperative pain in 

pluriradiculate teeth (60%). A similar result was found by Arias et al, who confirmed a higher 

incidence of postoperative pain in treated molars [3]. This may be explained by the fact that 

molars have a more complex anatomy and root canal morphology, particularly in the apical 

third, making complete debridement naturally more difficult, which predisposes to postoperative 

complications. 

 

Pain characteristics 

Various points have been observed to characterize pain (Table III): 

As for intensity, since pain is subjective, the pain perception threshold varies from one patient to 

another, despite the use of objective criteria to materialize it (VAS scale). In this study, the 5 to 7 

scale was qualified as moderate pain, accounting for 52% of the sample. 

This result is similar to Beach's 2013 study, they found post-endodontic pain of moderate 

intensity. [19] 

The majority of patients indicated that the pain was localized (66%), and as for the type of pain, 

it was persistent in 23.52% of respondents, pulsatile pain (17.64%), radiating pain (16.33%), the 

same proportion for provoked pain and compression-type pain (9.15%). 

According to the study by Pak JG and White SN, the clinical features of postoperative pain in 

endodontics are common to descriptions of acute apical periodontitis. It is a continuous, 

throbbing, well-localized pain, aggravated by occlusal pressure or periapical palpation. [1] 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
( ISSN: 2814-2098 )                                                                                               Andrianjafinoro Tsiriniaina Hasinjanahary1* 

http://ijojournals.com/ Volume 06 Issue 12 || Dec., 2023 || 

PSYCHOLOGICAL IMPACT OF POST-OPERATIVE ENDODONTIC PAIN 

 

 

 

 

In this study, many patients began to feel pain the day after the procedure (38%), its frequency 

was 1 to 5 times in 24 hours (70%), for 46% of them it diminished progressively over the course 

of the day.There is a similarity of results to other studies, According to Pak JG et al. pain sets in 

during the hours or days following treatment and diminishes substantially after treatment and 

especially during the first two days.[1]. 

The characteristics of pain vary from one subject to another, and depend on a number of 

physiological and physical circumstances. 

The possibility of taking medication 

Concerning the use of medication (Table IV), the study showed that the majority of patients took 

medication (66%). Analgesics were the most commonly taken type of medication, at 34%. 

Conversely, in France, according to Bronnec andal in 2011, the systematic prescription of 

NSAIDs is indicated after the procedure has been performed, and then for 24 to 48 hours [2]. 

According to Sipaviciute and Manelien (2014), taking nonsteroidal anti-inflammatory drugs 

(NSAIDs), either immediately before surgery, before local anesthesia is administered, or 

immediately after the procedure has been performed, significantly reduces both intraoperative 

and postoperative pain [13]. 

Based on these results, it will then be essential to provide patients with a prescription for 

analgesics for optimal prevention of postoperative pain, and for patients to take their analgesic 

treatment at a fixed time (every 6 hours) for at least 48 hours. 

 

Psychological impact of post-endodontic pain 

Endodontic pain is a source of great fear for patients, and endodontic therapy can be responsible 

for significant pain, which can have a psychological impact on patients. Thus, the impact of pain 

is not only physiological or physical, but also psychological. 

In the present study, due to the low representativeness of the sample, no factor was statistically 

correlated with postoperative pain. 

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( ISSN: 2814-2098 )                                                                                               Andrianjafinoro Tsiriniaina Hasinjanahary1* 

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PSYCHOLOGICAL IMPACT OF POST-OPERATIVE ENDODONTIC PAIN 

 

 

 

 

Three points were observed with regard to the psychological impact of postoperative pain (Table 

V): apprehension of pain (92%), fear of dentists (6%) and dental anxiety (12%). 

 Apprehension of pain 

Apprehension is defined as a fear in the face of danger that causes one to flee or avoid the 

situation. [20] 

According to gender, pain apprehension was predominantly experienced by women (86%), 

indicating that women presented a higher level of anticipated pain than men, and according to 

age, 84.2% of patients with pain apprehension were aged between 18 and 24 (Table VI). 

This result is consistent with the study by Catherine A andal. which found that women expected 

more sensory pain than men, and younger patients were more likely to expect higher levels of 

pain [21]. In view of these results, it may be that women are more concerned about pain and 

express it more, while men tend to minimize symptoms. 

Studies of specific noxious stimuli and brain activity indicate that women are better able to 

discriminate between stimulus levels than men [22]. 

These distinctions may be linked to differences in cortical brain activity. It has been shown that 

although both genders show similar bilateral activation of the premotor cortex and several 

contralateral structures, women have greater activation of the insula and contralateral 

thalamus than men[23]. 

As such, it is certainly possible that this greater activation could be linked to greater pain 

expression in women. 

Among the patients with pain apprehension, many presented pain of severe intensity (78.6%) 

and pain of moderate intensity (73.4%) (Table VII). 

A similar result was observed by Watkins CA andal. They carried out a study on 333 patients to 

compare expected and experienced pain intensities following endodontic treatment. The results 

highlighted that pain actually experienced was less than pain apprehended, and that patients 

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( ISSN: 2814-2098 )                                                                                               Andrianjafinoro Tsiriniaina Hasinjanahary1* 

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PSYCHOLOGICAL IMPACT OF POST-OPERATIVE ENDODONTIC PAIN 

 

 

 

 

not apprehending post-operative pain developed pain of lower intensity than those expecting to 

experience pain [24]. 

It could be that the pain being assessed is memorized pain from previous experience. 

 Fear of dentists 

Fear of the dentist can be described as a subjective state of feeling or reacting to a known source 

of danger, latent in the unconscious [25].It is well known and dates back hundreds of years. The 

origin of fear of the dentist is associated with pain [26]. 

Fear of the dentist" is the specific stress of the dental world, a phenomenon that is widespread 

throughout the world [27]. 

The prevalence of fear of dentists among adults varies from country to country. Nevertheless, 

many studies estimate the prevalence of this fear in the world population at between 15 and 

20%. [28,29] 

In the present study, more men (23.8%) than women (10.3%) were afraid of dentists (Table VIII). 

It could be that young men are confronted with various trials, some of which are physiological or 

even psychological, such as pain, which weakens their mental state due to a feeling they cannot 

master or control. The sensation of pain makes a man stressed and accentuates his stress by 

stimulating his uncontrollable imagination, often resulting in a state of fear. However, several 

studies have shown a higher prevalence in women. [40] 

As for age, it was found that the 25-34 age group experienced more fear(45, 5%). (Table VIII), a 

similar finding was observed according to the American Psychiatric Association, estimating that 

young adults are more inclined to trigger fear [30]. 

In terms of intensity, 19.4% of patients afraid of dentists reported moderate pain intensity 

(Table IX). 

A study by O'Keefe reported a significantly increased incidence of moderate to severe post-

operative pain in patients with a history of painful dental treatment, and whose most severe 

pain in their lifetime was dental in origin [27]. This association could be explained by fear of the 

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( ISSN: 2814-2098 )                                                                                               Andrianjafinoro Tsiriniaina Hasinjanahary1* 

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PSYCHOLOGICAL IMPACT OF POST-OPERATIVE ENDODONTIC PAIN 

 

 

 

 

dentist, leading patients to consult only during the severe stages of pain. This was confirmed in 

this study for patients who had already undergone endodontic treatment. The latter perceived 

less severe post-operative pain. 

 Dental anxiety 

Anxiety is an emotional disorder manifested by an indefinable feeling of insecurity. It is 

characterized by a sense of apprehension, tension, uneasiness and terror in the face of a peril of 

indeterminate nature. [31] 

Anxiety is a psychic state with a negative emotional manifestation that may be transient or part 

of a personality trait. 

It is often linked to a painful stimulus and an increased perception of pain. As a result, these 

patients feel pain more easily and for longer. The average prevalence of dental anxiety ranges 

from 13.1% to 19.8% of the population. The etiology of dental anxiety is multifactorial. The two 

factors most frequently cited in the literature are a bad experience at the dental surgery and/or a 

family member [32]. 

The present study found that 17.2% of patients who experienced dental anxiety were female 

(Table X). This result corroborates the study by Perkovic et al, who found that the 

preponderance of females was 57.6%. [33] 

According to Armfield JM, women are prone to signs of dental anxiety with higher scores than 

men[34].Similarly, several research studies assert that women are generally more anxious than 

men about dental care[35]. 

It could be that women, with their psychological and behavioural differences, as well as their 

fast-paced lives, are more confronted with the daily stresses that can lead to anxiety. 

According to age, patients aged 45 to 54 (60%) and 18 to 24 (15.8%) were the most anxious (Table 

X). 

In Perkovic's 2014 study, the highest age range was between 23 and 45 years, or 34% among 

anxious endodontic patients [36]. 

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( ISSN: 2814-2098 )                                                                                               Andrianjafinoro Tsiriniaina Hasinjanahary1* 

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PSYCHOLOGICAL IMPACT OF POST-OPERATIVE ENDODONTIC PAIN 

 

 

 

 

Analysis of other authors' results clearly shows a clear proportion of anxious people among 

seniors. Similarly, several studies show that older people generally have a higher degree of 

dental anxiety than younger people [35]. 

 The correlation between the present study and their research can be explained by the physical 

or physiological state of these patients, who no longer have the same alertness as before, and a 

present painful feeling can give rise to a state of stress that increases into anxiety. 

As for intensity, it was observed that 23,08% of anxious patients had pain of moderate intensity 

and 21,4% had pain of severe intensity (Table XI). 

Previous research has found that the intensity of post-endodontic pain in an anxious patient can 

vary according to the type and duration of endodontic treatment, the type and amount of local 

anesthesia, the type and dose of analgesics prescribed, as well as individual patient 

characteristics such as age, gender, general and oral health status, and previous dental 

experience. And the average intensity of post-endodontic pain in an anxious patient ranges from 

2 to 4 on a 0-10 visual analog scale (VAS) [33]. 

Post-endodontic pain usually peaks in the first 24 hours after endodontic treatment, then 

gradually decreases over the following days. [33] 

This may be because anxious patients tend to have negative expectations and overestimate the 

intensity of post-endodontic pain. 

Conclusion 

Post-operative pain is a subjective phenomenon, based above all on the patient's feelings, which 

makes it difficult to quantify, especially if the pain is not related to a lesion. 

This study has shown that the characteristics of postoperative pain in endodontics vary from one 

subject to another, depending on the type, intensity, onset and even evolution of the pain. In 

addition, post-endodontic pain has psychological impacts such as pain apprehension, fear of the 

dentist and dental anxiety. 

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( ISSN: 2814-2098 )                                                                                               Andrianjafinoro Tsiriniaina Hasinjanahary1* 

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PSYCHOLOGICAL IMPACT OF POST-OPERATIVE ENDODONTIC PAIN 

 

 

 

 

Post-operative pain management must be an integral part of endodontic care, and its impact on 

patient psychology must not be underestimated. To this end, it is essential that patients are 

informed of the possible post-operative consequences. 

Last but not least, an analytical study with representative samples would be desirable to gain a 

clearer picture of this pathology, which represents a real public health problem. 

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( ISSN: 2814-2098 )                                                                                               Andrianjafinoro Tsiriniaina Hasinjanahary1* 

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( ISSN: 2814-2098 )                                                                                               Andrianjafinoro Tsiriniaina Hasinjanahary1* 

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( ISSN: 2814-2098 )                                                                                               Andrianjafinoro Tsiriniaina Hasinjanahary1* 

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