Outcomes of root canal treatment in dental PBRN practices.

This study sought to quantify the incidence of root canal treatment (RCT) failure and identify its predictors in root canals that were performed or referred by general dentistry practices in a practice-based research network (PBRN). This retrospective cohort study involved 174 endodontically treated teeth. Mean duration from initial therapy to follow-up was 8.6 years. Permanent restorations were ultimately placed in 89% of teeth, although 18% of teeth were ultimately extracted anyway. Receiving a permanent restoration was a significant predictor of treatment failure (in other words, patients who did not receive a permanent restoration were more likely to experience RCT failure), whether failure was determined clinically or radiographically. This study of PBRN practices suggests a higher failure rate compared with studies that utilized highly controlled environments or populations with high levels of dental insurance.

Outcomes of root canal treatment in Dental Practice-Based Research Network practices.

This study sought to quantify the incidence of root canal treatment (RCT) failure and identify its predictors in root canals that were performed or referred by general dentistry practices in a practice-based research network (PBRN). This retrospective cohort study involved 174 endodontically treated teeth. Mean duration from initial therapy to follow-up was 8.6 years. Permanent restorations were ultimately placed in 89% of teeth, although 18% of teeth were ultimately extracted anyway. Receiving a permanent restoration was a significant predictor of treatment failure (in other words, patients who did not receive a permanent restoration were more likely to experience RCT failure), whether failure was determined clinically or radiographically. This study of PBRN practices suggests a higher failure rate compared with studies that utilized highly controlled environments or populations with high levels of dental insurance.

Racial differences in baseline treatment preference as predictors of receiving a dental extraction versus root canal therapy during 48 months of follow-up.

OBJECTIVE: This study aimed to test hypotheses that: a) treatment preference as stated at baseline predicts subsequent receipt of extraction (EXT) versus root canal treatment; and b) racial differences in treatment preference at baseline account for racial differences in receipt of these treatments during follow-up. METHODS: Data were taken from the Florida Dental Care Study This stratified random sample included at baseline 873 subjects, all of whom were 45-years-old or older, reported race as non-Hispanic African American or non-Hispanic white, and had at least one tooth. At baseline, participants were asked about past dental care characteristics, history of or current presence of various dental diseases and conditions, and sociodemographic circumstance. An EXT/root canal treatment "CHOICE" scenario was also queried at baseline. Predisposing, enabling, and need factors were tested as predictors of EXT/root canal treatment received during follow-up. Bivariate multivariable logistic regression analyses quantified associations between the outcomes (EXT/root canal) and the predictors. RESULTS: Receipt of EXT or root canal treatment during follow-up was strongly related to race even after people with mobile teeth at baseline were excluded from the analysis. Certain baseline factors (tooth mobility, periodontal attachment level, and ability to pay an unexpected dental bill) strongly predicted EXT/root canal treatment receipt during follow-up, although significant race effects remained; however, including "CHOICE" removed the race effect. CONCLUSIONS: Baseline treatment preference strongly predicts subsequent receipt of EXT versus root canal treatment. Racial differences in treatment received during follow-up were explained by baseline racial differences in treatment preference, tooth mobility, and periodontal status.

Racial differences in treatment preferences: oral health as an example.

RATIONALE, AIMS AND OBJECTIVES: Recent analyses from the Florida Dental Care Study found that response to a hypothetical scenario at baseline strongly predicted: (a) tooth loss during follow-up; and (b) subsequent receipt of either a dental extraction or Root Canal Therapy (RCT). The scenario ('CHOICE') required choosing either to: (1) extract the tooth before even knowing the cost of treatments; (2) extract, but after knowing the cost of all treatments; or (3) have RCT despite knowing costs. OBJECTIVE: The purpose of this study was to identify factors associated with CHOICE and quantify their effects. METHODS: As part of the baseline phase of the study, 873 subjects with at least one tooth and who were 45 years or older participated for an interview and dental examination. A multinomial multivariable regression of CHOICE quantified effects due to hypothesized predictors. RESULTS: CHOICE was strongly associated with race (African-Americans were significantly less likely to choose RCT). Results from the multivariable regression suggest that the race effect could be explained by racial differences in patient preference, treatment acceptability and ability to afford treatment. CONCLUSIONS: There were substantial racial differences in treatment preference even in this hypothetical scenario where racial differences in patient-provider interaction and clinical factors were not relevant. Certain predisposing and enabling variables explained these racial differences in treatment preference.

Effectiveness of Standardized Patient Simulations in Teaching Clinical Communication Skills to Dental Students.

The aim of this study was to investigate dental students' long-term retention of clinical communication skills learned in a second-year standardized patient simulation at one U.S. dental school. Retention was measured by students' performance with an actual patient during their fourth year. The high-fidelity simulation exercise focused on clinical communication skills took place during the spring term of the students' second year. The effect of the simulation was measured by comparing the fourth-year clinical performance of two groups: those who had participated in the simulation (intervention group; Class of 2016) and those who had not (no intervention/control group; Class of 2015). In the no intervention group, all 47 students participated; in the intervention group, 58 of 59 students participated. Both instructor assessments and students' self-assessments were used to evaluate the effectiveness of key patient interaction principles as well as comprehensive presentation of multiple treatment options. The results showed that students in the intervention group more frequently included cost during their treatment option presentation than did students in the no intervention group. The instructor ratings showed that the intervention group included all key treatment option components except duration more frequently than did the no intervention group. However, the simulation experience did not result in significantly more effective student-patient clinical communication on any of the items measured. This study presents limited evidence of the effectiveness of a standardized patient simulation to improve dental students' long-term clinical communication skills with respect to thorough presentation of treatment options to a patient.

Root canal treatment in a population-based adult sample: differences in patient factors and types of teeth treated between endodontists and general dentists.

OBJECTIVE: The purpose of this study was to identify in a population-based study the differences between general dentists and endodontists with regard to types of teeth treated, fees, and patient characteristics. BASIC RESEARCH DESIGN: The "Florida Dental Care Study" was a prospective cohort study using a representative baseline sample of 873 dentate adults. In-person interviews and clinical examinations were conducted at baseline, 24 months, and 48 months, with 6-monthly telephone interviews between those times. Dental record information was abstracted afterward. RESULTS: A total of 100 root canals were performed in participants during the study period. While generalists performed the majority of endodontic procedures in all teeth, the percentage of molars treated by endodontists was significantly higher than the percentage of anterior teeth and bicuspids treated by endodontists. Data on fees were available in 85 of the cases. The trend was for endodontists fees to be higher, but the difference in fees was statistically significant only for molars. There were no statistically significant differences between generalist and specialist patients with regard to income, fear of pain, and frustration from previous dental care. However, a significantly higher percentage of patients treated by endodontists had dental insurance. CONCLUSIONS: Although the number of teeth ultimately treated in this representative sample of a dentate population was small, results do suggest that endodontists' fees were higher, they performed a higher percentage of molar root canals, and their patients were more likely to have dental insurance, as compared to general dentists who did root canals.

Incidence of endodontic treatment: a 48-month prospective study.

The purpose of this study was to determine the incidence of endodontic services provided to participants in a longitudinal cohort study. The "Florida Dental Care Study" was a prospective cohort study using a representative baseline sample of 873 dentate adults. An in-person interview and clinical dental exam were conducted at baseline, 24, and 48 months after baseline, with telephone interviews every 6 months between those times. Dental record information was abstracted afterward. Thirteen percent of participants received at least one endodontic procedure after baseline. Endodontic services constituted approximately 2% of all dental procedures performed. Conventional root canal therapy comprised 94% of the endodontic services and was approximately evenly distributed among anterior teeth, premolars, and molars. Retreatment and apicoectomy each accounted for 3% of the endodontic procedures. The most common self-reported reasons for the dental visit in which a root canal occurred were "toothache," "abscess," and "dental sensitivity." A significant percentage of persons received some type of endodontic treatment in this diverse adult sample. Dental abscesses or toothaches were the main reason(s) for endodontic treatment, but not all persons with these conditions during follow-up sought dental treatment of any variety.

Comparison of endodontist versus generalist regarding preference for postendodontic use of cotton pellets in pulp chamber.

A degree of uncertainty exists about the use of cotton pellets in the pulp chamber after canal obturation. The purpose of this study was to poll practicing endodontists and generalists regarding their preference. Forty-six endodontists and an equal number of general dentists were polled in a mail survey regarding their preferences for the use of a cotton pellet in the pulp chamber after canal obturation. Eighty-seven percent of the endodontists and 54% of the generalists responded. Of the endodontists, 62.5% said they thought that the general dentist wanted a cotton pellet, contrasted to 80% of the generalists. The difference in proportions was not statistically significant.

Root canal treatment in a population-based adult sample: status of teeth after endodontic treatment.

The purpose of this study was to quantify treatment outcomes of endodontically treated teeth, in a representative, population-based adult sample. The "Florida Dental Care Study" was a prospective, longitudinal, cohort study of 873 subjects who had at least one tooth at baseline and who were 45 yr or older. An in-person interview and clinical examination were conducted at baseline, 24 months, and 48 months after baseline, with 6-monthly telephone interviews between those times. Dental record information was abstracted afterward. Seventy-five teeth had conventional root-canal therapy (RCT) performed and met the inclusion criteria of 1-yr of follow-up or extraction. The mean duration of follow-up after RCT was 24.8 months. The mean (SD) attachment loss (AL) on teeth receiving RCT was only 3.3 (1.4) mm. Permanent restorations were placed in 79% of teeth a mean of 4.4 months after the RCT. However, 12% of teeth did not have any restorative treatment after RCT. After RCT had been completed, 81% of teeth were retained and 19% were ultimately extracted. Taken as a whole, this community-based study of a representative sample of adults suggests a higher failure rate than reported from studies in highly controlled environments or insured populations. It also suggests that the length of time to initial restoration of RCT-treated teeth is less than optimal. RCT was almost never performed on teeth with advanced periodontal attachment loss.