Local Anesthetic Use and Intraoperative Pain During Root Canal Treatment: A Cross-Sectional Survey Among Dental Students, Postgraduates, and Endodontists

Objectives: This study investigated the use of local anesthetics (LA) during root canal treatment (RCT) among undergraduate dental students and specialists (postgraduates and specialists in Endodontics). Methods: A cross-sectional observation study was conducted among treatment providers, who completed a questionnaire at the end of a treatment visit. Results: A total of 134 treatment responses or patient encounters were included. Intraoperative pain (IOP) was reported in 25 (18.7%) responses, whereby 19 (14.2%) received supplementary anesthesia. A statistically significant association was observed between treatment procedure and IOP (p < 0.05), with the highest frequency of pain occurring during emergency treatment (55.6%) and the lowest during obturation (10.2%). No statistically significant associations were observed between IOP and pulpal diagnosis, treatment visit, or tooth type. Twenty-nine (21.6%) treatment providers (17.9% dental students and 25.4% specialists) carried out the RCT procedure without the use of LA. The use of LA differed significantly across diagnosis (p < 0.001) and treatment procedures (p < 0.05). Lidocaine was the most frequently used LA (84.7%). Anesthetic insufficiency (failure or inadequacy) was reported by treatment providers in 21 of 105 treatment encounters (20%) in which LA was administered. IOP was significantly associated with treatment by dental students (OR 7.6, 95% CI: 2.1–27.9; p < 0.01) and with the presence of preoperative symptoms (OR 2.9, 95% CI: 1.1–7.9; p < 0.05). LA was considered unnecessary by 43.2% of treatment providers in procedures where this response was recorded. Conclusions: Operator-reported anesthetic insufficiency was observed in approximately one in five (20%) treatment encounters in which LA was administered. Preoperative symptoms and operator training level may contribute to the occurrence of IOP and should therefore be considered when planning and delivering endodontic treatment.