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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 6  |  Issue : 1  |  Page : 22-27

Patients knowledge and attitude in endodontic treatment: A questionnaire-based study


Balaji Dental College and Hospital, Teynampet, Chennai, Tamil Nadu, India

Date of Submission06-Oct-2021
Date of Acceptance18-Oct-2021
Date of Web Publication29-Nov-2021

Correspondence Address:
Dr. M Dhanalakshmi
Balaji Dental College and Hospital, Teynampet, Chennai - 600 018, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijosr.ijosr_19_21

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  Abstract 


Introduction: The basic aspect of modern endodontics is painlessness and effectiveness of the treatment of diseased dental pulp. The disease of dental pulp is mainly caused due to dental caries. Dental caries is a common chronic disease prevalent all over the world. It is a microbiologic disease which manifests as demineralization of hard tissues of the tooth. If detected early, its management can be done easily via conservative techniques such as restorations. As it progresses to involve the vascular tissue of the tooth, it may cause symptoms such as pain and swelling. This leads patients to seek dental care. In addition, dental decay may cause tooth loss which can reduce the ability to eat fibrous foods, leading to dietary deficiencies. Root canal treatment (RCT) is a procedure that uses biologically acceptable chemical and mechanical treatment in the root canal system to eliminate pulpal and peri-radicular diseases and to promote healing and repair of peri-radicular tissue.The aim of this research is to study the patients' knowledge and attitude in endodontic treatment. Materials and Methods: A total of 13 questions were prepared and distributed to 100 patients in Private Dental College which included recording patients' knowledge and attitude toward root canal therapy. Results: About 68% of participants responded positively, but when asked in detail what RCT does and whether it is complicated, the responses were mixed and majority did not know or were not sure. Conclusion: From the self-prepared questionnaire and based on the responses acquired, it can be seen that on an average 58% of responses for all fifteen questions turned out to be positive and patients who had prior knowledge about RCT were interested in proceeding post endodontic treatments to increase the success of RCT.

Keywords: Crown, endodontics, knowledge, root canal, treatment


How to cite this article:
Dhanalakshmi M, Balaji A. Patients knowledge and attitude in endodontic treatment: A questionnaire-based study. Int J Soc Rehabil 2021;6:22-7

How to cite this URL:
Dhanalakshmi M, Balaji A. Patients knowledge and attitude in endodontic treatment: A questionnaire-based study. Int J Soc Rehabil [serial online] 2021 [cited 2022 Jan 28];6:22-7. Available from: https://www.ijsocialrehab.com/text.asp?2021/6/1/22/331476




  Introduction Top


Endodontics is the branch of dentistry that deals with diseases of the tooth root, dental pulp, and surrounding tissue in human. It is a profession based on the work with other people, so several factors should be considered during clinical decision-making process. The process of clinical decision-making is the essence of everyday clinical practice. This process involves an interaction of application of clinical and biomedical knowledge, problem-solving, weighing of probabilities and various outcomes, and balancing risk-benefit. Although most clinical decisions are based on “traditional” clinical criteria, they are also influenced by a wide range of non-clinical factors. Nonclinical influences on clinical decision-making affect medical decisions and it includes patient-related factors such as socioeconomic status, quality of life, and patient's expectations and wishes; physician-related factors such as personal characteristics and interaction with their professional community; and features of clinical practice such as private versus public practice as well as local management policies.

Endodontic treatment is performed to save the natural tooth. Most of the dentists agree that there is no substitute for healthy and natural teeth in spite of many advanced restorations. Publications on patient's awareness of endodontic procedures are rarely presented. Patients perceived problems related to endodontically treated teeth that are an important consideration for all dental practitioners. Contemporary endodontics is developing continuously. It concerns not only the instruments but also the treatment procedures. The basic principle of modern endodontics is painlessness and effectiveness of the treatment.[1],[2] The conviction of difficulties related to root canal treatment (RCT) including pain associated with it has been functioning among patients. It raises many concerns, which often lead to canceling the visits to the dental office.[3],[4] Many patients admit that they feel the stress related with the planned endodontic treatment. In all professions based on the work with other people, understanding of motivational processes and skills of using knowledge is very important.[5],[6]

In dentistry, RCT is the most feared procedure of all treatments. Dentist asserts that modem RCT is relatively painless because pain can be controlled. Major setback of RCT is that most patients lack the knowledge. They do not know what RCT entails and what the benefits of such treatment are. Most patients fear RCT because it is painful.[7]

Indications of RCT are irreversible pulpitis, periapical periodontitis, crown fractures involving the pulp, acute per apical abscess, when want to create post space, construction of an overdenture, and when the vitality of pulp is doubtful. RCT is contraindicated in patients with poor oral hygiene, poorly motivated patients, patients with poor general health, and the very old and in patients with infective endocarditits.


  Materials and Methods Top


A self-administered questionnaire was prepared and distributed to 100 patients in Private Dental College (convenience sampling) during their regular dental visits to assess the knowledge and attitude toward endodontic treatment. A total of 13 questions were included to record patients' knowledge and attitude toward root canal therapy. These ranged from personal details such as name and age to specific questions relating to awareness about root canal therapy, perceived barriers to undergo the same, and sources of knowledge regarding endodontics. The findings of this study will be used to come up with strategies to improve knowledge and practice of patients toward endodontic treatment [Figure 1].
Figure 1: Questionnaire

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  Results Top


The study records based on the questionnaire showed that 90 out of 100 patients contacted regarding the study responded positively and agreed to participate. Among the 90 patients, 22 patients were of 18–24 age group, 34 patients were of 25–30 age group, 19 of them were of 31–40 age group, and 15 of them were of 41–60 age group of the total participants.

Out of 90 participants, 61 (68% of 90 participants) respondents were aware that of RCT, other 15 (17% of 90 participants) of them were not aware, and 14 (15%) of them were not sure.

Thirty-one (34%) participants responded positively, 42 (47%) did not know, and the remaining 17 (19%) were not sure [Table 2].
Table 2: Response for root canal treatment involving cleaning and restoring up to the root of the tooth

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Thirty (33%) out of 90 participants think that RCT is a complicated procedure and 19 (21%) of them responded that RCT is not a complicated procedure and 41 (46%) of them did not know about it [Table 3].
Table 3: Patients response toward root canal treatment procedure

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Forty-three out of 90 (48%) participants responded that they have undergone RCT procedure, 10 (11%) of them did not undergo RCT procedure, and 37 (41%) of them were not sure if they had undergone RCT procedure [Table 4].
Table 4: Patients who have undergone root canal treatment procedure

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Twenty-five out of 43 (28%) participants who underwent RCT procedure felt that RCT was painful, 18 (20%) of them felt that it was not painful [Table 5].
Table 5: Patients response during treatment

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Out of 90 participants, 31 (34%) of them responded that they know how long will it take to finish RCT procedure, 42 (47%) of them agreed that they do not know about the time taken to finish the RCT procedure, and 17 (19%) of them were not sure about it [Table 6].
Table 6: Patients knowledge about the duration of the procedure

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More than 44% of the respondent preferred RCT and 23% consider extraction as the ultimate method. The remaining 40% had doubts about their preference [Table 7].
Table 7: Patients preference on root canal treatment

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Twenty-eight (31%) of respondents out of 90 participants admitted to knowing the price of RCT [Table 8].
Table 8: Patients response about the cost of root canal treatment procedure

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[Table 9] shows that 23 (26%) of 90 participants knew that procedures such as permanent filling or crowns after RCT are mandatory to determine the success of RCT [Table 9].
Table 9: Patients success rate on permanent filling or crowns after root canal treatment

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Out of 90 participants, 26 (29%) respondents said that they intend to continue treatment procedures after RCT [Table 10].
Table 10: Patients response on continuing procedures after root canal treatment

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[Table 11] shows the behavior of patients in case of a sudden, severe toothache. The majority of patients 67% would go immediately to a dentist after the first symptoms and 22% of respondents admit to using the “home remedies” to combat ailments.
Table 11: Patients response in case of toothache

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[Table 12] shows about the knowledge of the patient about endodontic treatment. Out of 90, 49 (54%) of the participants responded that they knew endodontic treatment through media or Internet, 18 (20%) knew from friends and family, the remaining 9 (10%) through the dentist, and 14 (26%) participants did not know.
Table 12: Patients knowledge on endodontic treatment

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[Table 13] shows attitude of the respondents. Out of 90 participants, 60 (66%) of them responded that RCT is necessary in case of toothache or broken tooth, 23 (26%) of them responded that RCT is necessary in case of change in tooth color.
Table 13: Patients opinion on root canal treatment

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  Discussion Top


The study was conducted based on a self-prepared questionnaire circulated among 100 patients visiting Saveetha dental college, Chennai. Out of 100, 90 patients answered the questionnaire and 10 patients were not interested to answer the questionnaire. There are 15 direct questions focused on the awareness and attitude toward endodontic procedures in the participants. Majority of participants belonged to the age group of 25–30 years (38%). When asked pertaining to their awareness, maximum (68%) participants responded positively, but when asked in detail what RCT does and whether it is complicated, the responses were mixed and majority did not know or were not sure [Table 1]. The participants were then questioned about their previous experiences with RCT, a maximum of 48% of participants had prior experience [Figure 2], and about 28% responded they did not have pain during the procedure and 20% had pain during treatment [Figure 3]. When asked about the duration to complete RCT and would they prefer it over the extraction of tooth, only 33%–34% responded positively and majority had doubts. To the next questions about the cost, success, and further treatment, about 25%–31% responded positively that they knew about the cost and were aware and willing to follow-up treatments such as permanent restoration and crowns to improve the success rate, but still, a majority did not know the cost and further treatment options. A large percentage of participants 67% responded that they would go to a dentist when there is an incidence of pain and the remaining 33% chose either home remedies or were not sure. About 84% of participants had prior interest in knowing about endodontics either through media, friends, family, and dentists; majority of participants believed that RCT is necessary in case of broken tooth or pain associated with the tooth.
Figure 2: Representing patient's knowledge on root canal treatment

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Figure 3: Graph representing majority of 58% had prior experience, 22% of the patients were not aware of the procedure, and 30% were not sure

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Table 1: Awareness of root canal treatment

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The main aim of a RCT is the complete removal of the connective tissue and the destruction of residual microorganisms found in infected root canals and an effective seal to prevent recolonization of the root canal system with bacteria. Thus, the primary endodontic treatment goal must be to ensure root canal disinfection and to prevent re-infection. Irrigating solutions play a very large role in disinfecting the root canals. Today, the use of laser to remove smear layer and to disinfect root canals has increasingly attracted attentions.[8] The complexity of the root canal system, presence of numerous dentinal tubules in the roots, invasion of the tubules by microorganisms, formation of smear layer during instrumentation, and presence of dentin as a tissue are the major obstacles in achieving the primary objectives of complete cleaning and shaping of root canal systems.[9]

In recent years, endodontics has been one of the fastest-growing areas of dentistry. The use of modern tools, rubber dam, and the microscope in daily practice significantly influences the quality and durability of treatment effects. All endodontic procedures should be performed with a rubber dam, which should be considered standard care. The purpose of rubber dam protection in dentistry on whole cannot be overemphasized.[10] Patients more often do not identify the endodontic treatment as the most unpleasant procedure. Endodontic procedures with associated pain is felt as moderate, rarely sharp. In addition, patients can benefit from many forms of local anesthesia, and the use of nitrous oxide, which according to recent reports, enhances the effect of their actions. Other forms of premedication are preoperative intravenous sedatives and analgesics. In extreme cases, general anesthesia is the alternative. A study conducted by Klages et al. demonstrates that patients visiting the dental office expect pain usually larger than that actually experiencing during treatment.[11] One of the fastest-growing areas of dentistry in recent years is observed to be endodontics. The quality and durability of the treatment has become more effective after the use of modern tools (the rotary nickel–titanium files which have enabled a quicker root canal preparation, as these instruments produce a uniformly tapered canal configuration with minimum canal transportation and also reduce the incidences of periradicular irritation and postoperative discomfort, but only about one-fifth of respondents use these rotary instruments in root canal preparation, whereas the others use nonrotary manual endodontic files), rubber dam, and microscope in daily practice.[12]

The conviction of difficulties related to RCT including pain associated with it has been functioning among patients. It raises many concerns, which often lead to canceling the visit to the dental office. Many patients admit that they feel the stress related with the planned endodontic treatment. Publications on patients' awareness of this type of procedure are rarely presented. Contemporary endodontics is developing continuously. It concerns not only the instruments but also the treatment procedures. The basic principle of modern endodontics is painlessness and effective of the treatment. There are many methods providing the patient with comfort by reducing pain during treatment: local and conduction anesthesia, nitrous oxide, or even general anesthesia. Successful RCT depends not only on specific factors such as root canal infection and complexity of root canal morphology. Majority of RCT in India is provided by general dental practitioners. Various investigations are, therefore, carried out to explore the standard of RCT carried out by them. The antibiotics should be used judiciously for well-defined indications in endodontics. The antibiotics use should only be considered as an adjunct to nonsurgical endodontic therapy. At the end, the dentists should have a sound knowledge about the endodontic indications for the prescription of antibiotics to restrict and prevent the misuse and overuse of antibiotics.[13]

According to the study done by Sisodia N et al., it indicates that most of the barriers reported to acceptability of root canal therapy could be overcome by patient education and creating increased general awareness about oral health and different dental procedures through school dental health education programs.[14] As the dentist is the most common source of information for most patients, the onus of appropriate dissemination of knowledge lies with them. This can be done most effectively in the dental office by placing pictorial pamphlets which describe RCT and crowns in the waiting area. Nonoperating office staff can additionally help in increasing awareness by explaining the importance of retaining and replacing teeth while the patient is in the waiting area.[15],[16]

In all professions based on the work with other people, understanding of motivational processes and skills of using knowledge is very important. These factors are particularly important in everyday practice of a dentist.[17] Properly conducted interview with the patient helps in deciding on the appropriate therapeutic treatment, especially with regard to endodontics, which often prevents tooth loss.[18] Since the beginning of modern-day endodontics, there have been numerous concepts, strategies, and techniques for performing pain-free and reasonable cost RCT. The level of patients' knowledge and awareness regarding RCT may influence their decision-making and choice; it may be an obstacle to get the treatment.[14],[19]


  Conclusion Top


From the self-prepared questionnaire and based on the responses acquired, it can be seen that on an average 58% of responses for all 15 questions turned out to be positive and patients who had prior knowledge about RCT were interested in proceeding post endodontic treatments to increase the success of RCT. The next major focus was the 30% of participants who responded doubtfully, steps can be taken to clear their doubts by means of explaining what and how RCT and other endodontic procedures done, it can be done during the diagnosis and treatment planning or even during dental camps and awareness programs conducted separately.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hamedy R, Shakiba B, Fayazi S, Pak JG, White SN. Patient-centered endodontic outcomes: A narrative review. Iran Endod J 2013;8:197-204.  Back to cited text no. 1
    
2.
Pak JG, White SN. Pain prevalence and severity before, during, and after root canal treatment: A systematic review. J Endod 2011;37:429-38.  Back to cited text no. 2
    
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Georgelin-Gurgel M, Diemer F, Nicolas E, Hennequin M. Surgical and nonsurgical endodontic treatment-induced stress. J Endod 2009;35:19-22.  Back to cited text no. 3
    
4.
Bracha HS, Vega EM, Vega CB. Posttraumatic dental-care anxiety (PTDA): Is “dental phobia” a misnomer? Hawaii Dent J 2006;37:17-9.  Back to cited text no. 4
    
5.
Klages U, Ulusoy O, Kianifard S, Wehrbein H. Dental trait anxiety and pain sensitivity as predictors of expected and experienced pain in stressful dental procedures. Eur J Oral Sci 2004;112:477-83.  Back to cited text no. 5
    
6.
Wellstood K, Wilson K, Eyles J. 'Reasonable access' to primary care: Assessing the role of individual and system characteristics. Health Place 2006;12:121-30.  Back to cited text no. 6
    
7.
Hajjaj FM, Salek MS, Basra MK, Finlay AY. Non-clinical influences on clinical decision-making: A major challenge to evidence-based practice. J R Soc Med 2010;103:178-87.  Back to cited text no. 7
    
8.
Abraham S, Raj JD, Venugopal M. Endodontic irrigants: A comprehensive review. J Pharm Sci Res 2015;7:5-9.  Back to cited text no. 8
    
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Parthasarathy P. Awareness and knowledge of dentists about laser technique used in endodontic disinfection. J Pharm Sci Res 2017;9:476-9.  Back to cited text no. 9
    
10.
Srinivasan S, Pradeep S. The attitude of dentists towards the prescription of antibiotics during endodontic treatment – A questionaire based study. Int J Pharm Technol 2016;8:15895-900.  Back to cited text no. 10
    
11.
Bamgartner JC. Antibiotics in endodontic therapy. In: Antibiotics and Antimicrobial Use in Dental Practice. Carol Stream. 2001. p. 143-57.  Back to cited text no. 11
    
12.
Pooja Umaiyal M. Awareness of root canal treatment among people. Res J Pharm Technol 2016;9.  Back to cited text no. 12
    
13.
Jyothi H, Pradeep. Practice of endodontic therapy among practitioners: A questionnaire based study. Int J Pharm Technol 2016;8:16546-58.  Back to cited text no. 13
    
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Janczarek M, Cieszko-Buk M, Bachanek T, Chałas R. Survey-based research on patients' knowledge about endodontic treatment. Pol J Public Health 2014;124:134-7.  Back to cited text no. 14
    
15.
Sisodia N, Yadav S, Nangia T, Singh P, Yadav M, Singh HP. Dental patients' knowledge and attitude towards endodontics – A survey. J Pharm Biomed Sci 2015;05:80-3.  Back to cited text no. 15
    
16.
Eli I, Schwartz-Arad D, Bartal Y Anxiety and ability to recognize clinical information in dentistry. J Dent Res 2008;87:65-8.  Back to cited text no. 16
    
17.
Gatten DL, Riedy CA, Hong SK, Johnson JD, Cohenca N. Quality of life of endodontically treated versus implant treated patients: A university-based qualitative research study. J Endod 2011;37:903-9.  Back to cited text no. 17
    
18.
Butani Y, Weintraub JA, Barker JC. Oral health-related cultural beliefs for four racial/ethnic groups: Assessment of the literature. BMC Oral Health 2008;8:26.  Back to cited text no. 18
    
19.
Mehata N, Raisingani D, Gupta S, Sharma M. Endodontic trends: Where we are and where we should be – A survey report. People's. J Sci Res 2013;6:30-7.  Back to cited text no. 19
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11], [Table 12], [Table 13]



 

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