OR11 - Clinical and Psychosocial Predisposing Factors Associated With Anesthesia Failure During Nonsurgical Root Canal Retreatment: A National Dental Practice-Based Research Network Study

Wednesday, April 2, 2025

12:45 PM – 1:00 PM EST

Location: Hynes Convention Center, Floor 3, Room 309

Presenter(s)

Linda J. Liu, D.D.S.

Resident
University of Minnesota School of Dentistry
Blaine, Minnesota

Disclosure information not submitted.

Co-Author(s)

Ronald Ordinola Zapata, D.D.S., M.S., Ph.D.

Associate Professor
University of Minnesota School of Dentistry
Roseville, Minnesota

Disclosure(s): No financial relationships to disclose
Alan S. Law, D.D.S., PhD (he/him/his)

Endodontist
The Dental Specialists
Department of Endodontics, University of Minnesota
Woodbury, Minnesota

Disclosure(s): No financial relationships to disclose
W Craig Noblett, D.D.S., M.S. (he/him/his)

Director, Division of Endodontics
University of Minnesota School of Dentistry
Minneapolis, Minnesota

Disclosure information not submitted.
Donald R. Nixdorf, D.D.S., M.S.

Professor
University of Minnesota School of Dentistry
University of Minnesota
Minneapolis, Minnesota

Disclosure information not submitted.
EF

Ellen Funkhouser, Ph.D.

Associate Professor
University of Alabama at Birmingham
McCalla, Alabama

Disclosure information not submitted.

Disclosure(s):

Ronald Ordinola Zapata, D.D.S., M.S., Ph.D.: No financial relationships to disclose

Alan S. Law, D.D.S., PhD: No financial relationships to disclose

Objective: This study aimed to identify practitioner, patient, and pre-treatment clinical characteristics associated with local anesthesia failure.

Methods: Data were collected from the National Dental Practice-Based Research Network and included 1,723 patients. Local anesthesia failure was defined by 1) provider-reported use of additional local anesthesia and 2) patient-reported pain ≥3 (on a 0-10 scale). Pre-treatment factors included dentist and patient demographics, patient psychosocial constructs, and pre-treatment clinical findings (cold, biting, percussion, palpation). Characteristics with p<.1 (after adjustment for clustering with generalized estimating equations) were entered into a full model to identify independent associations with failed anesthesia. Odds ratios were calculated to measure the strength of these associations.

Results: For provider-reported need for additional anesthesia, anesthesia failure was associated with mandibular teeth (p <.001), molars (p =.004), and more pre-treatment diagnostic findings (p <.001). Factors inversely correlated with additional use of anesthesia were: practitioner age ≥65 (p=.048), non-Hispanic white or Asian ethnicity (p=.03), and pre-treatment radiolucency (p=.001). For patient-reported pain ≥3, failure was linked to practitioner age ≥65 (p=.02), dental fear (p=.04), mandibular teeth (p=.003), and more pre-treatment diagnostic findings (p=.04). Protective factors included endodontist practitioners (=.005) and the patient being non-Hispanic white (p=.003).

Conclusion: Endodontists experienced fewer anesthesia failures. Mandibular teeth, molars, and more pre-treatment diagnostic findings increased failure risk, while lower dental fear and certain ethnicities (possibly related to socioeconomic factors and access to dental care) were linked to fewer anesthesia failures.