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Psychosomatic Medicine 63:453-462 (2001)
© 2001 American Psychosomatic Society

ORIGINAL ARTICLES

Pain and Immunologic Response to Root Canal Treatment and Subsequent Health Outcomes

Henrietta L. Logan, PhD, Susan Lutgendorf, PhD, H. Lester Kirchner, PhD, Eric M. Rivera, DDS, MS and David Lubaroff, PhD

From the Division of Public Health Services and Research (H.L.L.), University of Florida, Gainesville, Florida; Departments of Psychology (S.L.), Endodontics (E.M.R.), and Urology and Microbiology (D.L.), University of Iowa, Iowa City, Iowa; and Department of Pediatrics (H.L.K.), Case Western Reserve University, Cleveland, Ohio.

Address reprint requests to: Henrietta Logan, PhD, Box 100404, 1600 SW Archer Rd., D8-39, Public Health Services and Research, University of Florida, Gainesville, FL 32610. Email: hlogan{at}dental.ufl.edu

OBJECTIVE: This study examined the effects of pain and stress associated with a dental procedure, root canal treatment (RCT), on natural killer cell cytotoxicity (NKCC) and the subsequent development of symptoms of upper respiratory illness during the following month.

METHODS: Patients (N = 33) were recruited from those scheduled for RCT appointments. Subjects for a non-RCT comparison group (N = 14) were also recruited from dental clinic patients. Peripheral blood was drawn by use of an indwelling catheter three times: just before RCT, 30 minutes after injection of a local anesthetic, and 30 minutes after RCT (a parallel time course was followed for the comparison group.) Blood was assayed for cortisol and NKCC. Subjects completed a health diary in the month after RCT.

RESULTS: Patients showed a significant increase in NKCC between baseline and RCT and a significant decrease from RCT to after RCT, whereas the comparison group did not. The NKCC following the RCT was negatively correlated with the pain level during RCT (r = -0.48, p < .01) and pain levels 2 and 6 hours after RCT (r = -0.43, p < .05; r = -0.44 p < .05, respectively). The patient group reported significantly more illness episodes 2 weeks after RCT than the comparison group (Wilcoxon rank sum = 4.78, p = .03). Discriminant function analysis correctly classified 88% of the subjects into the illness category using predictor variables of post-RCT NKCC, stress, and pain levels during RCT (F(3,21) = 8.23, p < .001).

CONCLUSIONS: Transitory changes in NKCC associated with pain and stress may be implicated in the development of infectious disease episodes after an acute stressful event.

Key Words: pain • stress • natural killer cell cytotoxicity • health outcomes • dental procedures.

Abbreviations: IV = intravenous; NK = natural killer cells; NKCC = natural killer cell cytotoxicity; RCT = root canal treatment.






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Copyright © 2001 by the American Psychosomatic Society