Evaluation of Dental Interns' Perception and Self-Confidence Levels Regarding Endodontic Treatment"- A Questionnaire Study

ABSTRACT Objective: To evaluate the perception and self-confidence of Dental interns regarding endodontic treatment performed on patients. Material and Methods: A total of 111 dental interns from 5 different educational institutes of a state in South India participated in a questionnaire-based survey. The questionnaire consisted of 12 questions related to root canal procedures performed on patients. Analysis was done using SPSS version 17.0. Results: Sixty-five interns (59%) performed less than 10 root canal treatments on patients during the course of the internship. Twenty-eight interns (25% of the intern population) took up more than 10 root canal treatment cases, whereas only 18 interns (16%) did not perform the treatment on patients and answered the questionnaire based on their experience with extracted teeth model work. Only five interns out of 111 were 'Very confident' and 22 were 'Confident' in performing the root canal treatment. Conclusion: The present study indicates that the self-perceived confidence level among dental interns can affect their clinical performance. It also recommends additional hands-on workshops, problem-based learning and clinical guidance for the dental interns to become more confident with the root canal procedure.

Non-linear indices of heart rate variability during endodontic treatment

Abstract Dental treatment promotes psychosomatic change that can influence the procedure and compromise the general well-being of the patient. In this context, it highlights the importance of evaluating the function of the autonomic nervous system in individuals undergoing endodontic treatment. Thus, this manuscript aimed to analyse cardiac autonomic modulation, through non-linear indices of heart rate variability (HRV) during endodontic treatment. Analysis of 50 subjects of either sex aged between 18 and 40 years diagnosed with irreversible pulp necrosis of lower molars undergoing endodontic treatment was undertaken. We carried out fractal and symbolic analysis of HRV, which was recorded in the first session of the endodontic treatment at four intervals: T1: 0-10 min before the onset of the treatment session; T2: 0-10 min after the application of anaesthesia; T3: throughout the period of treatment; and T4: 0-30 min after the end of the treatment session. There was reduction of α1 in T2 compared to T1 and T4 (p < 0.0001). The α2 index also reduced in T2 compared to T3 (p = 0.0035). There was an increase in the α1/α2 ratio in T4 compared to T2 and T3 (p = 0.0003). It was found that 0V% was significantly lower in T2 (p = 0.002), while 2UV% was significantly higher (p < 0.0001) when compared to other points in time. In conclusion, HRV is reduced during endodontic treatment, and after applying local anaesthetic the parasympathetic component of HRV increases. These data indicate that endodontic treatment acutely overcharges the heart, supporting the stress involved in this situation.

Patient perceived burden of implant placement compared to surgical tooth removal and apicectomy.

OBJECTIVE: To assess how patients actually perceive implant placement, to evaluate whether patients' perceived burdens are related to specific stages during implant placement, and to compare patients' perceptions during implant placement with other surgical procedures. METHODS: A sample of 287 patients was consecutively recruited. Only patients with implantations (n=45), surgical tooth removal (n=147), or apicectomies (n=95) were included. Patients' perceptions during oral surgery and implantation were assessed using the Burdens in Oral Surgery Questionnaire (BiOS-Q). Effects of treatment on BiOS-Q total and domain scores were assessed using multivariate linear regression analyses, and effect sizes (Cohen's d) were computed. RESULTS: Overall, patients' perceived burdens during oral surgery were low indicated by a mean BiOS-Q total score of 28.5 points, with lowest scores for Side effects (19.4) and highest scores for Anesthesia (34.1). Among treatment groups, implantation was perceived least unpleasant. This was related to lower burdens during Bone and soft tissue manipulation during implantation than during surgical tooth removal (difference: 14.8 points; d=0.8) or apicectomy (difference: 13.1 points; d=0.7). CONCLUSIONS: Implantation has a low overall perceived burden and is significantly less burdensome during bone and soft tissue manipulation than surgical tooth removal or apicectomy. CLINICAL SIGNIFICANCE: Patients can be informed that implant placement is less unpleasing than other commonly performed oral surgery procedures.

Assessment of anxiety related to dental treatments among patients attending dental clinics and hospitals in Ranga Reddy District, Andhra Pradesh, India.

PURPOSE: To assess the levels of dental anxiety among patients anticipating dental treatments in dental clinics/hospitals of Ranga Reddy district. MATERIALS AND METHODS: A cross-sectional study was conducted among a representative sample of 1200 subjects (at least 18 years old) in dental clinics/hospitals which were selected from a list obtained through systematic random sampling. The data were collected using a pre-tested and calibrated questionnaire consisting of the Modified Corah Dental Anxiety Scale (MDAS) to assess anxiety levels. RESULTS: The majority (52.4%) of subjects showed a low level of anxiety. Females (11.44 ± 4.41) were found to have higher mean MDAS scores than males, and the highest mean MDAS scores were found among 18- to 34-year-olds (11.28 ± 4.67) (P < 0.05). Significant differences were found among subjects anticipating different treatments, with higher MDAS scores for extraction (11.25 ± 5.4), followed by examination, root canal treatment, gum surgery, scaling, restoration and others, e.g. orthodontic treatment, restoration with crowns, bridges and dentures (7.79 ± 3.80). The highest mean MDAS scores were found among subjects who were apprehensive due to 'past difficult experience in dental treatments', followed by 'drill' and 'injection', with the lowest scores among subjects indicating 'other reasons' (7.82 ± 3.84). CONCLUSION: The present data show that anxiety levels are higher in patients who have to undergo extractions than those who must be fitted with dentures. Thus, dental health care providers should pay more attention to patients' anxiety levels associated with different types of treatment.

A survey of dentists' preferences for the treatment of teeth with apical periodontitis.

INTRODUCTION: This study surveyed the preferences of Ontario, Canada dentists for teeth with apical periodontitis when selecting between retention via root canal treatment (RCT) and extraction without replacement, or replacement with implant-supported crowns (ISC), fixed, or removable partial prostheses. METHODS: A mail-out survey (census of Ontario endodontists, periodontists, prosthodontists, and oral and maxillofacial surgeons; n = 498, 40% response rate) and a Web-based survey (sample of Ontario general dentists; n = 1983, 15% response rate) were conducted. Participants ranked their treatment preferences for 4 clinical scenarios: an anterior or posterior tooth, without or with previous RCT. Associations between treatment preferences and covariates were explored by using bivariate and logistic regression analyses (P ≤ .05). RESULTS: For all 4 scenarios, the majority of participants preferred either RCT or ISC, whereas other treatment options were preferred by ≤ 3.1% of the participants in any professional registration category. A pattern of declining preference for RCT and increasing preference for ISC was noted across the scenarios, with significantly lower preference for RCT and higher preference for ISC associated with teeth needing repeated RCT compared with initial RCT (odds ratio [OR] = 3.3; confidence interval [CI], 2.5-4.4). Preferences were significantly lower for RCT and higher for ISC among general dentists (OR = 6.4; CI, 2.3-17.6), prosthodontists (OR = 9.1; CI, 3.0-28.3), periodontists (OR = 18.3; CI, 6.4-51.6), and surgeons (OR = 30.1; CI, 10.8-86.6) when compared with endodontists. CONCLUSIONS: More surveyed dentists preferred RCT than ISC for teeth with apical periodontitis requiring initial RCT than repeated RCT. The dentists' preferences were associated with their professional registration but not with other characteristics.

Effect of platelet concentrate on quality of life after periradicular surgery: a randomized clinical study.

INTRODUCTION: Control of postoperative discomfort might enhance the patient's quality of life and treatment acceptance. The aim of the present randomized single-blind study was to evaluate whether the use of platelet concentrate during endodontic surgery might have a favorable impact on pain and other factors related to patient's quality of life during the first week after surgery. METHODS: Eighteen patients with periapical lesion were treated with modern endodontic surgical procedure (control group). In another 18 patients, in adjunct to surgical procedure, platelet concentrate was applied on the root end in liquid form, within the bone defect in clot form, and over the suture in liquid form (test group). All patients completed a questionnaire for evaluation of main symptoms and daily activities during the first week after surgery. The outcomes of the questionnaires of the 2 groups were statistically compared. RESULTS: The test group showed significantly less pain and swelling, fewer analgesics taken, and improved functional activities as compared with the control group. CONCLUSIONS: The adjunct of platelet concentrate to the endodontic surgical procedure produced significant beneficial effect to patients' quality of life during the early postoperative stage.

Effect of presentation bias on selection of treatment option for failed endodontic therapy.

OBJECTIVE: The purpose of the study was to determine if treatment option presentation bias affects decision making by patients when they have failed endodontic therapy. STUDY DESIGN: First-year dental students simulated the role of patients. All students were given the same scenario of a symptomatic tooth with failed endodontic therapy and asked to select from between 2 treatment options: nonsurgical endodontic retreatment or extraction and implant placement. One half of the students had characterizations of the treatment options biased toward nonsurgical retreatment, and the other half had characterizations of the treatment options biased toward extraction and implant selection. Statistical analysis was performed with chi-squared test. RESULTS: Biased presentations significantly influenced the treatment selection by the students (P = .0006). CONCLUSION: If treatment options are presented in a biased manner to favor one option, the patient is more likely to select that treatment option.

Dental difficulty for adult patients undergoing different dental procedures according to level of dental anxiety.

This study aimed to determine the level of dental anxiety before different dental care procedures. A group of 116 adults presenting for the first time at a French dental hospital were included in the study. These patients completed a French-language version of Corah's Dental Anxiety Scale 1 and used a visual analogue scale to score their perception of the level of difficulty generated by 13 different dental treatments. The acts perceived as the most difficult to face were root canal and restorative treatment without local anaesthesia (LA), followed by oral surgery. There was a positive correlation between DAS score and level of difficulty experienced during dental treatment. Healthy subjects declared difficulty in coping with dental care. Dental procedures may be a factor of co morbidity in terms of the psychological status of dental patients. A classification of dental procedures is given according to the level of difficulty generated.

Dental anxiety among patients prior to different dental treatments.

The purpose of the present study was to evaluate dental anxiety among patients anticipating various dental treatments. One hundred and eighty patients who were scheduled for specific dental treatments at the School of Dental Medicine, the Hebrew University--Hadassah, Jerusalem, Israel participated in the study. Patients were anticipating one of the following dental procedures: scaling, filling, root canal therapy, preparation for crown, periodontal surgery or extraction. For each of the six dental treatments, 30 patients were selected at random. Dental Anxiety Scale (DAS) questionnaires were completed by the patients while waiting for their treatments. The results indicated that extraction caused the highest score, followed by scaling (though not significantly). Patients in the 35 to 49 year age group showed the highest total DAS scores. Women demonstrated higher total DAS scores than men. The relative influence of gender, type of treatment and age on the anxiety scores is demonstrated by using logistic regression, which revealed gender to have the strongest impact on the DAS scores, followed by the type of treatment and age.

Delayed root canal therapy: an analysis of treatment over time.

A retrospective study of 898 teeth receiving root canal therapy was performed to document the sequelae of delayed completion of root canal treatment. Teeth were categorized into a prompt treatment group and a delayed treatment group. Comparisons of prompt and delayed treatment groups were made with regard to preoperative pain, interappointment emergencies, postobturation pain, and final treatment. Findings from this study show that a palliative endodontic procedure is an extremely effective treatment. However, 56% of teeth with incomplete root canal therapy eventually were extracted compared with 2 to 3% for the root canal filling treatment groups. By emphasizing the potential loss of the tooth rather than the potential of interappointment emergencies, the clinician may be more effective in achieving compliance among patients receiving delayed treatment.

A comparison of anxiety levels associated with root canal therapy and oral surgery treatment.

Questionnaires regarding experience, hearsay, and perceptions of anxiety toward eight dental treatments were distributed to a general patient population. Data revealed that among 349 respondents 35% heard that root canal therapy was the most unpleasant dental treatment, whereas 29% listed oral surgery treatment as having the worst reputation. However, 53% of those experiencing oral surgery treatment stated that an oral surgery treatment was the most unpleasant treatment whereas only 17% experiencing root canal therapy stated the same for root canal therapy. On the basis of anxiety scores, root canal therapy and oral surgery treatment were categorized in the high-anxiety category, crowns, dentures, and fillings in the moderate-anxiety category, and cleaning, sick call, and examination in the low-anxiety category. The anxiety levels of root canal therapy and oral surgery treatment were then analyzed as they related to different experience groups (combinations of root canal therapy and oral surgery and experience), hearsay experience, and most unpleasant experience with root canal therapy and oral surgery. Patients having experience with root canal therapy or oral surgery treatment had lower anxiety levels toward these respective treatments than did those who had no such experience. Patients who have heard negative stories (hearsay) of root canal therapy and oral surgery showed higher levels of anxiety toward these respective treatments than did those who have not heard such stories. But former endodontic patients who had heard negative stories about root canal therapy actually recorded lower anxiety levels toward root canal therapy than those patients with no negative hearsay experience.(ABSTRACT TRUNCATED AT 250 WORDS)

Stress, relaxation, and saliva: a pilot study involving endodontic patients.

Thirty-four endodontic patients completed dental anxiety questionnaires and had saliva samples taken prior to and at the conclusion of their initial endodontic treatment. Pain and anxiety were managed with local anesthesia, nitrous oxide--oxygen psychosedation, hypnosis, and meditation, either alone or in combination. For most patients, by the conclusion of the treatment, anxiety had decreased, salivary volume had increased, and salivary protein was reduced. Meditation and hypnosis, either alone or in combination with local anesthesia, were most effective in anxiety reduction as measured by questionnaire and/or salivary changes.