Risk Factors and Prevalence of Occupational Musculoskeletal Pain among Endodontists in the United States.

INTRODUCTION: A musculoskeletal disorder (MSD) of pain, weakness, numbness, or paresthesia is a common issue for dental health care providers. The aims of this study were to (1) identify the prevalence of MSDs among endodontists in the United States, (2) to identify risk factors of MSDs among United States endodontists, and (3) to compare these findings with other published findings for dental providers. METHODS: A 24-question survey regarding the demographics, potential risk factors, and prevalence of MSDs was formulated and distributed to 5394 members of the American Association of Endodontists. Data were then analyzed using descriptive statistics and chi-square analysis to find significance at α = 0.05. RESULTS: Six hundred twenty participants responded to the survey for an overall response rate of 12%. Of the submitted surveys, 527 of them confirmed to be endodontists practicing in the United States, and all results were derived from those 527 surveys. Seventy-four percent of respondents reported having experienced MSDs in the last 12 months, and 88% reported having experienced at least 1 MSD thus far during their career. Eighty-five percent of female participants reported an MSD within the past 12 months compared with 70% of males. CONCLUSIONS: MSDs have a high prevalence among endodontists in the United States. The neck and lower back were the areas of highest MSD prevalence. Female sex and the frequent adoption of awkward postures were factors associated with significantly higher rates of reported MSDs in the last 12 months.

The Validity of Pulp Tests on Crowned Teeth: A Clinical Study.

OBJECTIVE: The aim of this study was to evaluate the sensitivity and specificity of electric pulp testing (EPT) using the bridging technique in comparison to a cold test on crowned teeth. METHODS: Thirty teeth were included in this study. Only one crowned tooth from each subject was included. The adjacent teeth served as controls. The crowned teeth were tested for pulp vitality using a bridging EPT technique and cold test. Vitality was confirmed upon access based on bleeding or lack of bleeding from detected root canal systems. The data was statistically analyzed using the McNamara test (P<0.05). RESULTS: The sensitivities of the cold test and bridging EPT were 87% and 66% respectively. Accuracy for cold and bridging EPT were 87% and 67% respectively. The cold test demonstrated a statistically significant higher accuracy and sensitivity than the bridging EPT. However, no significant difference was detected in the specificity between the two tests. CONCLUSION: Both EPT and cold test should be considered as an adjunctive diagnostic tool when determining pulp status in a crowned tooth. Pulp sensitivity tests are essential but the results should be interpreted in combination with other clinical signs/symptoms.

The Effect of Crown Lengthening on the Outcome of Endodontically Treated Posterior Teeth: 10-year Survival Analysis.

INTRODUCTION: The purpose of this study was to investigate the effect of a crown lengthening (CL) procedure and the crown-root ratio after CL on the long-term survival of endodontically treated teeth (ETT). METHODS: Permanent posterior teeth with opposing dentition that had received adequate nonsurgical root canal treatment (NSRCT) and a full-coverage crown between January 1, 2006, and January 1, 2016 were included in this retrospective study. The data collected included dates of the NSRCT, time of extraction if extracted, age, sex, location, the crown-root ratio after CL, and the presence of a lesion. All included ETT were divided into 2 groups: RESULTS: 5-year survival rates of ETT in the control and CL groups were 88.6% and 82.2%, respectively (P > .05). The 10-year survival rates of ETT in the control and CL groups were 74.5% and 51%, respectively (P < .05). ETT that received the CL procedure after NSRCT were almost 2.3 times more likely to get extracted compared with ETT that did not need the CL procedure at the 10-year follow-up (hazard ratio = 2.29, P < .05). Also, ETT with an inadequate crown-root ratio (1:1) after CL showed the lowest survival rate (40%) compared with ETT with an adequate crown-root ratio (<1:1). CONCLUSIONS: A crown-root ratio of 1:1 after osseous CL may affect the long-term survival of ETT. Despite the promising survival rate of ETT with an adequate crown-root ratio after CL, the long-term survival of NSRCT with an inadequate crown-root ratio (1:1) should be considered in the treatment planning phase. Also, it is worth mentioning that the results of the present study should be evaluated in future prospective studies.

Regenerative Endodontics: A Systematic Analysis of the Failed Cases.

INTRODUCTION: The aim of this systematic review was to analyze failed cases of regenerative endodontic treatment (RET) reported in the literature in terms of etiology, diagnosis, treatment protocols, signs of failure, and additional endodontic interventions. METHODS: Electronic searches were performed in PubMed, Web of Science, and ProQuest Dissertations & Theses databases. All in vivo publications in humans that reported at least 1 failed case of RET were included in this systematic review. Failed RET cases were defined in the current study as any case that required an additional endodontic intervention or extraction after the completion of the initial RET. RESULTS: A total of 28 studies that reported 67 failed cases of RET were included in this review. A total of 37 failed RET cases reported the etiology that resulted in the initiation of RET; 59% of these cases were caused by dental trauma, and 30% were caused by dens evaginatus. A total of 26 (39%) failed RET cases were detected at least 2 years after the initiation of RET. A total of 53 (79%) failed RET cases were presented with signs and/or symptoms of persistent infection. CONCLUSIONS: Persistent infection was the main presentation in 79% of failed RET cases. Furthermore, 39% of failed RET cases were identified after more than 2 years of follow-up. Future studies should include a detailed description of the etiology, preoperative variables, intraoperative protocols, and postoperative follow-up to provide a better understanding of failed cases after RET.

The Effect of Lunasin on Receptor Activator of Nuclear Factor Kappa-B Ligand-mediated Osteoclast Formation from RAW 264.7 Cells.

INTRODUCTION: To date, no study has investigated the antiresorptive property of lunasin. Hence, the present study aimed to assess the ability of lunasin to inhibit the osteoclast formation using RAW 264.7 cells. We hypothesized that lunasin is able to inhibit osteoclast formation. METHODS: In the present study, the murine monocytic cell line RAW 264.7 was induced to differentiate into mature osteoclasts in the presence of recombinant receptor activator of nuclear factor kappa-B ligand. Tartrate-resistant acid phosphatase, a marker of osteoclasts, was used to identify osteoclasts. Cell lines were divided into different groups and exposed to different concentrations of 50 µmol/L, 75 µmol/L, and 100 µmol/L active and inactive lunasin. The control group was RAW 264.7 cells with receptor activator of nuclear factor kappa-B ligand. Tartrate-resistant acid phosphatase-positive cells of 3 or more nuclei, indicative of mature osteoclasts, were counted by 3 observers. The mean number of the data collected was analyzed using 1-way analysis of variance and the multiple comparison post hoc Bonferroni correction. RESULTS: There was a significant difference in the reduction of osteoclast formation in all the active lunasin groups (P < .001) compared with the control group and the inactive lunasin group (P < .001). CONCLUSIONS: Considering the suppressive effect of lunasin on osteoclastogenesis, the use of lunasin as a potential antiresorptive agent can be evaluated in future studies.

Comparison of IL-1ß, TNF-α, hBD-2, and hBD-3 Expression in the Dental Pulp of Smokers Versus Nonsmokers.

INTRODUCTION: To date, the endodontic literature lacks research on the effect of smoking on cytokine and defensin expression in the dental pulp. Therefore, the aim of this study was to investigate the expression of interleukin (IL)-1ß, tumor necrosis factor (TNF)-α, human beta defensin (hBD)-2 and hBD-3 in the dental pulp of smokers and compare them with nonsmokers. We hypothesized that cytokine and defensin expression would be reduced in smokers as compared with nonsmokers. METHODS: Thirty-two smokers and 37 nonsmokers with endodontic pulpal diagnoses of normal, symptomatic irreversible pulpitis and asymptomatic irreversible pulpitis were included in this cross-sectional study. Samples from pulp chambers were collected and stored in phosphate-buffered saline at -80°C. Luminex was used to measure IL-1ß and TNF-α levels. The levels of hBD-2 and hBD-3 were measured using enzyme-linked immunosorbent assay. Marker levels were normalized to protein concentrations and data were analyzed using Kruskal-Wallis test, Mann-Whitney U test, and 2-way analysis of variance (α = 0.05). RESULTS: Pulpal concentrations of TNF-α and hBD-2 were significantly lower among smokers (P < .01), whereas no significant difference was observed for IL-1ß, or hBD-3. Two-way analysis of covariance revealed that smoking status (P < .001), not endodontic diagnosis (pulpal status), significantly affected TNF-α and hBD-2 levels. CONCLUSIONS: This study reported that smokers are immunologically deficient in TNF-α and hBD-2, suggesting that dental pulps of smokers possess limited defense mechanisms, affecting their endodontic prognosis and indicating a cause for their reported inferior outcome.

The Association between the Anatomic Landmarks of the Pulp Chamber Floor and the Prevalence of Middle Mesial Canals in Mandibular First Molars: An In Vivo Analysis.

INTRODUCTION: The present study aimed to determine the incidence and anatomic variation of the middle mesial (MM) canal in mandibular permanent first molars using cone-beam computed tomographic imaging and to evaluate the association between the presence of MM canals and anatomic landmarks of the pulp chamber floor in the mesial root. METHODS: In this in vivo cross-sectional study, 210 CBCT scans of mandibular fist molars from 210 patients were included. CBCT scans were evaluated in 3 sections, and the following data were collected for further analysis: identification of the MM canal, the distance between the mesiobuccal (MB) and mesiolingual (ML) orifices, the presence of any isthmus between the MB and ML orifices, and the MB and ML root canal system (RCS) configurations. Binary logistic regression was performed to assess the effect of pulp floor anatomic characteristics as an independent variable on the outcome variable (the presence of an MM canal). RESULTS: The overall prevalence of the identification of an MM canal regardless of age was 14.7%. Mandibular first molars with an isthmus between the MB and ML RCS configurations were almost 5 times more likely to show an MM canal (P < .05, odds ratio [OR] = 4.9). The MB-ML intraorifice distance was inversely associated with the presence of an MM canal (P < .05, OR = 0.73). Patients less than 42 years old were 4 times more likely to have an MM canal in their CBCT scans compared with patients older than 42 years old (P < .05, OR = 3.9). CONCLUSIONS: The suggested anatomic landmarks of the pulp chamber floor could act as a reliable predictive factor for the presence of an MM canal. This knowledge of anatomic clues may serve to better direct endodontists in locating an MM canal, which could prevent excessive removal of tooth structures.

Apical Periodontitis, a Predictor Variable for Preeclampsia: A Case-control Study.

INTRODUCTION: Preeclampsia (PE) is characterized by hypertension and proteinuria after the 20th week of gestation. There is an association between systemic inflammation and adverse pregnancy outcomes such as PE. Therefore, for the first time, the present study aimed to investigate the possible association between maternal apical periodontitis (AP) and PE. METHODS: In this case-control study, 50 mothers who were diagnosed with PE during pregnancy were included in the experimental group. The control group consisted of 50 matched mothers with a normal course of pregnancy. The endodontic and periodontal status of all participants was reviewed using the digital panoramic radiographs that were available before pregnancy. The number of remaining teeth and the presence of AP in all teeth and endodontically treated teeth were recorded using the periapical index. Binary logistic regression was used to determine the possible association between AP and PE (α = 0.05). RESULTS: AP in at least 1 tooth was found in 27 of the mothers who developed PE (54%) and in 16 of the control patients (32%) (odds ratio [OR] = 2.4, P < .05). Adjusted for the maternal periodontitis, number of teeth, and endodontic treatment, maternal AP was significantly associated with the occurrence of PE (P < .05; OR = 2.23; 95% confidence interval, 95% = 1.92-6.88). CONCLUSIONS: AP was significantly more prevalent in the experimental group. For the first time, this study has provided evidence that maternal AP may be a strong independent predictor of PE. Considering the high occurrence of PE, particularly in developing countries, it could be suggested that the risk of PE may be reduced through comprehensive dental examinations for detecting and treating any source of inflammation, including AP, before pregnancy.

The Influence of Periodontal Status on Endodontically Treated Teeth: 9-year Survival Analysis.

INTRODUCTION: The aim of this study was to investigate the effect of periodontal status at the time of nonsurgical root canal treatment (NSRCT) on the survival rate of endodontically treated teeth (ETT). METHODS: In this retrospective investigation, molars that received NSRCT in an advanced specialty education program in endodontics from 2009 through 2017 were initially recruited. After the application of inclusion and exclusion criteria, 315 teeth were included in the study. Inclusion criteria were ETT with an acceptable quality of NSRCT; ETT that received an adequate crown within 3 months after NSRCT; and ETT with complete periodontal charting before NSRCT including pocket depths, clinical attachment loss, and bone loss. The periodontal status of all included teeth was assessed based on American Academy of Periodontology guidelines. All included ETT were divided into 3 groups as follows: healthy group, mild periodontitis, and moderate periodontitis. The survival rate of ETT was analyzed using univariate Kaplan-Meier and log-rank tests for differences between groups (P < .05). A Cox regression model was used to assess the effect of independent variables on the survival rate. RESULTS: Teeth that were diagnosed with mild periodontitis were almost 2 times more likely to be extracted compared with ETT diagnosed with normal periodontium at the time of NSRCT (odds ratio [OR] = 1.9, P < .05). This increased risk of tooth loss was 3.1 (OR = 3.1, P < .05) for ETT diagnosed with moderate periodontitis. Smokers were twice as likely to have tooth loss compared with nonsmokers (OR = 2.2, P < .05). CONCLUSIONS: Patients' periodontal health, being 1 of the prognostic determinants of the outcome of NSRCT, requires attention before and subsequent to NSRCT. This may improve the survival of ETT and help patients maintain their natural dentition.

Association of End-stage Renal Disease with Radiographically and Clinically Diagnosed Apical Periodontitis: A Hospital-based Study.

INTRODUCTION: The present study aimed to evaluate the prevalence of apical periodontitis (AP) and endodontic treatment in patients with end-stage renal disease (ESRD) as compared with patients with no history of ESRD. METHODS: In this cross-sectional study, 40 patients diagnosed with nondiabetic ESRD were included. The control group consisted of 40 age-matched and sex-matched healthy individuals. Digital panoramic radiographs were exposed on patients in both the experimental and control groups. The number of remaining teeth and the prevalence of nonsurgical and/or surgical root canal treatment were evaluated. Also, the presence of AP in all teeth and endodontically treated teeth (ETT) was recorded using the periapical index. Logistic regression was used to determine the possible association between ESRD and AP. RESULTS: AP in at least 1 tooth was found in 29 of the patients with ESRD (73%) and in 16 of the control patients (40%) (odds ratio [OR] = 3.9, P < .05). In 21 (52%) patients with ESRD in the experimental group, at least 1 ETT was diagnosed with AP. In the control group, 11 (28%) individuals had AP affecting at least 1 of the ETT (OR = 2.9, P < .05). Adjusted for the number of teeth and endodontic treatment, ESRD was significantly associated with the presence of AP (P < .05; OR = 2.6; 95% confidence interval, 1.43-4.8). Also, the number of teeth with AP was significantly associated with the urea serum level in the experimental group (P < .05, ß coefficient = 4.35). CONCLUSION: AP was significantly more prevalent in the experimental group. This may suggest that ESRD could possibly alter the pathogenesis of AP. However, these findings do not confirm the presence of any cause-and-effect relationship between these conditions. Also, considering the modifying effect of AP on urea serum level, the treatment of AP could be incorporated in the treatment planning of patients with ESRD.

The Effect of the Dental Operating Microscope on the Outcome of Nonsurgical Root Canal Treatment: A Retrospective Case-control Study.

INTRODUCTION: The aim of the current investigation was to assess the effect of the use of a dental operating microscope on the outcome of nonsurgical root canal treatment (NS RCT) while treating the mesiobuccal (MB) root of the maxillary first molar. METHODS: This retrospective investigation included endodontically treated maxillary first molars (ETMs) with apparent adequate previous NS RCT and restorations referred for endodontic retreatment at the endodontic graduate clinic. Inclusion criteria were ETMs that were diagnosed with irreversible pulpitis and normal periapical tissues before the initial NS RCT and ETMs that presented with a minimum of 1 identifiable periapical lesion (PAR) at 1 of the roots at the time of retreatment. One hundred ninety-five ETMs were included and divided into 2 groups: (1) the initial NS RCT had been performed using a microscope (n = 83) and (2) NS RCT had been performed without the use of a microscope (n = 112). Data extracted were whether the second MB (MB2) canal was located initially and the presence of an MB PAR at the time of retreatment. Data were statistically analyzed using binary logistic regression (α = 0.05). RESULTS: The MB root was 3 times more likely to present with a PAR at the time of retreatment if the initial NS RCT was performed without the use of a microscope (P < .05, odds ratio = 3.1). There was a significant association between a missed MB2 canal and an MB PAR in the group in which the initial NS RCT was performed without the use of a microscope (P < .05, odds ratio = 5.1). However, in cases in which the initial NS RCT was performed using a microscope, a missed MB2 canal was not associated with the presence of an MB PAR. CONCLUSIONS: With proper education, dentists can gain further insight into recognizing limitations in treating cases that require advanced training and advanced optics such as a microscope. Based on this strategy, it would appear that the outcome of NS RCT can be improved.

Association between Systemic Diseases and Endodontic Outcome: A Systematic Review.

INTRODUCTION: To date, the relationships between systemic diseases and endodontic treatment outcomes remain poorly studied. Thus, the purpose of this systematic review was to evaluate the relationship between host-modifying factors and their association with endodontic outcomes. METHODS: Two reviewers independently conducted a comprehensive literature search. The MEDLINE, Embase, Cochrane, and PubMed databases were searched. In addition, the bibliographies and gray literature of all relevant articles and textbooks were manually searched. There was no disagreement between the 2 reviewers. RESULTS: Sixteen articles met the inclusion criteria with moderate to high risk of bias. There was no article with low risk of bias. Available scientific evidence remains inconclusive as to whether diabetes and/or cardiovascular disease(s) may be associated with endodontic outcomes. Human immunodeficiency virus and oral bisphosphonate did not appear to be associated with endodontic outcomes. CONCLUSIONS: Although additional well-designed longitudinal clinical studies are needed, the results of this systematic review suggest that some systemic diseases may be correlated with endodontic outcomes.

The Effect of Various Concentrations of Nitrous Oxide and Oxygen on the Hypersensitive Gag Reflex.

The purpose of this study was to compare the effectiveness of various concentrations of N2O/O2 on obtunding a hypersensitive gag reflex. We hypothesized that the administration of nitrous oxide and oxygen would obtund a hypersensitive gag reflex enough to allow a patient to tolerate the placement and holding of a digital x-ray sensor long enough to obtain a dental radiograph. Volunteers claiming to have a hypersensitive gag reflex were first screened to validate their claim and then tested by placing a size 2 digital x-ray sensor in the position for a periapical radiograph of the right mandibular molar area and holding it in place for 10 seconds. Subjects were first tested using room air only, then 30%, 50%, or 70% nitrous oxide until they were able to tolerate the sensor without gagging or discomfort. A visual analog scale was used for subjective responses, and other statistical tests were used to analyze the results. We found that for some subjects, 30% nitrous oxide was sufficient; for others, 50% was needed; and for the remainder of the subjects, 70% was sufficient to tolerate the test. Using a combination of 70% nitrous oxide and 30% oxygen allowed all patients claiming to have a hypersensitive gag reflex to tolerate the placement and holding of a digital x-ray sensor long enough to take a periapical radiograph.

Eight-Year Retrospective Study of the Critical Time Lapse between Root Canal Completion and Crown Placement: Its Influence on the Survival of Endodontically Treated Teeth.

INTRODUCTION: The purpose of this study was to investigate the effects of factors associated with various coronal restorative modalities after root canal treatment (RCT) on the survival of endodontically treated teeth (ETT) and to assess the effect of time lapse between RCT and crown placement after RCT to form a tooth loss hazard model. METHODS: Computerized analysis was performed for all patients who received posterior RCT from 2008 to 2016 in the graduate endodontic department. Data collected included dates of RCT, type of post-endodontic restoration, and time of extraction if extracted. Teeth that received crown after RCT were also divided into 2 groups: receiving crown before 4 months and after 4 months after RCT. Data were analyzed by using Kaplan-Meier log-rank test and Cox regression model (α = 0.05) by using SPPS Statistic 21. RESULTS: Type of restoration after RCT significantly affected the survival of ETT (P = .001). ETT that received composite/amalgam buildup restorations were 2.29 times more likely to be extracted compared with ETT that received crown (hazard ratio, 2.29; confidence interval, 1.29-4.06; P = .005). Time of crown placement after RCT was also significantly correlated with survival rate of ETT (P = .001). Teeth that received crown 4 months after RCT were almost 3 times more likely to get extracted compared with teeth that received crown within 4 months of RCT (hazard ratio, 3.38; confidence interval, 1.56-6.33; P = .002). CONCLUSIONS: Patients may benefit by maintaining their natural dentition by timely placement of crown after RCT, which otherwise may have been extracted and replaced by implant because of any delay in crown placement.

Association between Systemic Diseases and Apical Periodontitis.

INTRODUCTION: To date, the relationships between systemic diseases and periapical microbial infection remain unknown. Thus the purpose of this systematic review was to evaluate the relationship between host modifying factors and their association with endodontic pathosis. METHODS: Two reviewers independently conducted a comprehensive literature search. The MEDLINE, Embase, Cochrane, and PubMed databases were searched. In addition, the bibliographies of all relevant articles and textbooks were manually searched. There was no disagreement between the 2 reviewers. RESULTS: Sixteen articles were identified and included. The overall quality of the studies and the risk of bias were rated to be moderate. Only 3 studies demonstrated a low level of bias. CONCLUSIONS: The results of this review suggest that there may be a moderate risk and correlation between some systemic diseases and endodontic pathosis. More prospective and longitudinal research in this area is warranted to determine greater specificity in these possible interactions to potentially decrease or minimize the effects of systemic disease on the formation of apical periodontitis.

Determination of mutagenicity of the precipitate formed by sodium hypochlorite and chlorhexidine using the Ames test.

The aim of this study was to determine the direct mutagenic potential of any precipitate formed by combining sodium hypochlorite (NaOCl) and chlorhexidine (CHX). The precipitates formed by NaOCl and CHX were dissolved in 100% dimethyl sulfoxide and cultured with mutant Salmonella Typhimurium strains. The cells were observed for reverse mutation. The numbers of positive/mutated wells were statistically compared with those in the background plates using the two-sample proportion independent t-test. The precipitates were not found to be significantly more mutagenic than the background plates. Within the limitations of this study, the results suggest that the precipitates formed when sodium hypochlorite and chlorhexidine contact did not show mutagenic (and are therefore carcinogenic) potential.

Are more endodontic consultations needed in dental school clinic settings? A study of treatment decisions at one school.

With no previous studies of the occurrence of interdisciplinary consultations for tooth extraction in a dental school clinic setting, the aim of this cross-sectional descriptive investigation was to measure and compare the consultation process that occurred among departments at one U.S. dental school for making treatment decisions on tooth extraction. A comprehensive computerized retrieval (Crystal Reports) was used to identify and gather data from patient records from July 1, 2007, to July 1, 2011. Treatment plans and progress notes were analyzed to determine why each tooth had been extracted and which department had recommended the extraction. Results showed that the clinical departments involved in treatment planning decisions were the DMD dental student clinic, Department of Periodontics, and Department of Endodontics. The narrative records of 227 patients who had 516 teeth extracted were examined. About three-fourths (73.26%) of the extracted teeth were extracted based on the recommendation of only one department. Of these extracted teeth, 22.0% (n=114) were previously endodontically treated, and only four were recommended for endodontic consultation prior to extraction. The study found that most extractions were performed without specialty consultations and that the Department of Endodontics was consulted the least of all departments. To foster interdisciplinary collaboration in dental school clinics and help students develop expertise in such collaborations, more specialty consultations are needed for teeth that are treatment planned for extraction in order to preclude needless extraction of potentially salvageable teeth. Doing so will provide benefits for both patient care and students' education.

Influence of demographics on patients' receipt of endodontic therapy or implant placement.

INTRODUCTION: With the recent advancement in dental treatment modalities, patients are increasingly faced with the dilemma of selecting between root canal treatment (RCT) and implant placement (IP). Data on the influence of demographics on the aforementioned choice appear to be limited. The purpose of this retrospective cohort study was to investigate any association between demographic attributes and patients' receipt of RCT or IP. METHODS: The study sample for this computerized retrospective cohort study included 4084 dental school patients who received RCT and/or IP between 2006 and 2011. The following data were abstracted for each patient: age, sex, ethnicity, insurance status, and zip codes; the last variable was the proxy for socioeconomic status (SES). Statistical analysis included descriptive, chi-square test, and computation of odds ratios. RESULTS: Patient age, sex, race, insurance status, and SES were significantly associated with the choice of endodontic or implant therapy. Older patients were 6 times more likely as younger ones to receive IP. Males were 1.3 times more likely as females to have received IP; whites were twice as likely as blacks for the same treatment. Insured patients were 1.6 times more likely to have received RCT compared with uninsured patients The odds of patients from high SES receiving IP was 2.4 times greater than those from low SES. CONCLUSIONS: Demographic attributes and insurance status significantly affected the receipt of RCT or IP. Clinicians need to be aware that patient demographics and/or dental insurance status play a role in treatment decisions.

Assessment of patients' awareness and factors influencing patients' demands for sedation in endodontics.

INTRODUCTION: Endodontic therapy is perceived by many as a procedure to be feared. Many studies have reported that fear and anxiety are major deterrents to seeking dental care in general, but only a few deal with the use of sedation in endodontic therapies. The purpose of this study was to assess patients' awareness of and factors influencing the potential demand for sedation in endodontics. We hypothesized that there is an association between demographic factors and the demand for sedation in endodontics. METHODS: A survey consisting of 24 questions was given to patients 18 years and older who presented to the graduate endodontic clinic. Results were collected and statistically analyzed. RESULTS: Thirty-six percent of patients reported that their perception of sedation was being put to sleep, and 27% perceived it as related to or reducing pain. Concerns associated with endodontic therapy were the fear of pain (35%), fear of needles (16%), difficulty getting numb (10%), and anxiety (7%). The 2 major demographic factors that influenced the demand for sedation were cost and the level of anxiety (P < .05). Fifty-one percent showed a positive interest in sedation for endodontic therapy if the option of sedation was available. CONCLUSIONS: The demand for sedation in endodontics is high. Patients' understanding of sedation varies. More patients would consider having endodontic procedures if sedation was available. The provision of sedation by endodontists could result in more patients accepting endodontic therapies.

The critical time-lapse between various restoration placements and subsequent endodontic intervention.

INTRODUCTION: The purpose of this study was 2-fold: (1) to investigate the critical time-lapse of endodontic intervention subsequent to various restorations and tooth surfaces and (2) to assess and compare the risk factors associated with the restorations, tooth surfaces, and endodontic treatment. METHODS: A comprehensive computerized analysis of all dental school patients at the Case Western Reserve University School of Dental Medicine who received restorations from 2008-2013 was obtained. Inclusion and exclusion criteria were applied. The sample size was limited to teeth with endodontic treatment completed by the endodontic postgraduate dental clinic. Data collected included restoration type, restored tooth surfaces, tooth type, and the dates of restoration and subsequent endodontic treatment. A 2-sample paired t test (95% confidence interval, P < .05) and pair-wise comparison with Bonferroni corrections were implemented. RESULTS: The mean time between restoration placement and resultant endodontic intervention was 270 days, with a mean difference of 247-294 days (P < .0001). Further analysis revealed composite resin was 1.91 times more likely than amalgam and 5.69 times more likely than crowns to cause resultant endodontic intervention. Teeth with 2 or more restorative surfaces required endodontic intervention (P < .001). CONCLUSIONS: Of the patients who required endodontic treatment after restoration placement, the critical time-lapse was 9 months. Composite restorations and teeth with 2 or more restorative surfaces were significantly associated with endodontic treatment. From the results of the current study, we recommended that all dental practitioners should perform a thorough endodontic evaluation and diagnosis before, during, and after all restorative procedures.