Ethnicity and Pathways of Fear in Endodontics

Cultural topics with clinical implications needed in the dental curriculum to develop intercultural competence: A systematic review

OBJECTIVE

To identify cultural topics with clinical implications to be incorporated into the dentistry curriculum to develop Intercultural Competence.

METHODS

Systematic review with PRISMA criteria that exported 216 articles from the Web of Science, Scopus, and SciELO databases from 2012 to 2022, of which 40 were selected. The inclusion criteria were theoretical and empirical scientific articles, of quantitative, qualitative, or mixed methods nature, on cultural topics.

RESULTS

The data analysis allowed the organization of information into four cultural topics: Development of professional intercultural self-awareness, Individual, family, and cultural implications, Construction of intercultural therapeutic relationships, and Specific clinical aspects, each with particular contents to be developed in the dentistry curriculum. However, some clinical issues have yet to be explored in-depth, leaving research possibilities open to all disciplines in dentistry. Additionally, it is necessary to analyze the cultural bias in the discussion and conclusion of some reviewed articles, as they were conducted from an ethnocentric perspective. Thus, peer reviewers of scientific journals and researchers in these topics must have appropriate training in Intercultural Competence.

CONCLUSIONS

This review provides a guide and pedagogical sequence of the cultural topics that should be incorporated into the dentistry curriculum to achieve Intercultural Competence, it also highlights a wide range of relevant aspects to consider in establishing an adequate therapeutic relationship. Explicit accreditation criteria contribute to the establishment of Intercultural Competence in the curricula; however, in countries that lack regulations, there is a moral and ethical duty to incorporate the subject so that the future professional can manage and establish inclusive healthcare.

Factors Associated with Patients' Rejection of Root Canal Treatment in a Tertiary Hospital, Southwest Nigeria: A Pilot Survey

Objective

Root canal treatment (RCT) is a major procedure in dentistry. It aims to relieve the pain of pulpal origin and maintain the affected tooth as a functional unit on the arch. Despite these achievable goals, RCT is sometimes rejected by patients. This study, therefore, sought to assess the reasons for rejection in patients planned for endodontic/RCT.

Materials and Methods

This was a cross-sectional pilot survey of patients planned for RCT using a self-administered questionnaire. The questionnaire included sociodemographics, the Index for Dental Anxiety and Fear (IDAF-4C), and questions to assess the reasons for rejection of endodontic treatment. Data collected were analysed with IBM Statistical Package for the Social Sciences software program, version 23.0. Descriptive statistics were used; chi-square was used to test the association between categorical variables. Statistical significance was set at P ≤ 0.05.

Result

Thirty-one patients between the age range of 16 and 81 years, with a mean age of 38.16 ± 17.87, participated in the survey. Only nine (29.03%) of the participants declined to have the treatment. The majority 6(66.7%), and 7(77.8%) of those that refused the treatment did so, due to fear of drilling (P = 0.014) and cost of treatment (P = 0.001), respectively. Mean IDAF-4C was 1.86 ± 0.9 (standard deviation).The rejection was, however, not affected by past experience, the risk of taking multiple radiographs, and the number of hours or visits for the procedure.

Conclusion

The cost of treatment and fear of drilling were the major reasons for the rejection of RCT in this study. Therefore, there is a need to further look into making endodontic treatment a more comfortable, less costly, and less fear-provoking procedure for patients.

Levels of Anxiety and Fear Related to Non-Surgical Root Canal Treatment Performed by Endodontic Residents and Endodontists

Objectives

Despite advances in endodontic treatment procedures, root canal treatment is still associated with anxiety and fear. This may cause care avoidance and subsequent oral complications due to untreated endodontic infections. Anxiety and fear levels in response to non-surgical root canal treatment performed by endodontic residents and endodontists were analyzed.

Methods

A descriptive, cross-sectional survey was conducted among patients visiting the endodontic clinics at the University Dental Hospital. The questions addressed the participant's demographics, previous root canal treatment visits, clinician's level of training, and post-treatment experience.

Results

Demographics play a role in anxiety and dental fear in root canal treatment. Men scored significantly lower in the high-anxiety category than women, and patients treated by endodontic residents expressed lower levels of anxiety. Post-treatment experience of an endodontist or endodontic resident was a significant factor in reducing dental fear and anxiety.

Conclusion

The level of anxiety and fear related to root canal experience of endodontists or endodontic residents is very low. Most of the patients expressed willingness to undergo further root canal treatment to save a tooth.

Present status and future directions - Mechanisms and management of local anaesthetic failures

Pain control during root canal treatment is of utmost importance for both the patient and the dental practitioner and many studies have investigated ways of overcoming problems with gaining adequate anaesthesia during treatment. The PubMed and Cochrane databases were searched for evidence-based studies regarding local anaesthesia for root canal treatment. Many variables, including premedication, pain during needle insertion, pain on injection, premedication with various types of drugs, volume of anaesthetic solutions, supplemental anaesthetic techniques, and additives to the anaesthetic solutions, may influence pain perception during root canal treatment. Differences between teeth with healthy pulps versus those with irreversible pulpitis should be considered when the effects of variables are interpreted. There are several concerns regarding the methodologies used in studies that have evaluated anaesthesia success rates. There are some conditions that may help to predict a patient's pain during root canal treatment and these conditions could be overcome either by employing methods such as premedication with a non-steroidal anti-inflammatory drug prior to the treatment visit or by using supplementary anaesthetic techniques before or during the treatment. However, authors need to be more careful when reporting details of their studies to reduce concerns regarding their study bias.

Assessment of yogic relaxation techniques for its anxiolytic effects in patients requiring endodontic treatment: A prospective, randomized controlled study

Background:

The aim of the study is to assess the anxiolytic effects of yogic relaxation technique (YRT) in patients requiring root canal treatment (RCT).

Materials and Methods:

In this prospective, randomized, placebo-controlled study, 30 patients undergoing RCT with baseline visual analog scale for anxiety (VAS-A) of score >4 were divided into Group 1: YRTs; Group 2: alprazolam (0.25 mg/0.5 mg), and Group 3: placebo. After 30 min of completion of YRT, endodontic treatment was performed. Reduction in anxiety was analyzed using state anxiety score (domain) of the state-trait anxiety inventory scale.

Results:

There was no significant difference in anxiety score 1 h before RCT between groups (P = 0.401). Ten minutes before (P < 0.0001) and after RCT (P < 0.0001), there was significant difference between groups (yogic relaxation vs. alprazolam [P < 0.0001]; yogic relaxation vs. placebo [P < 0.0001]). Ten minutes before RCT, yoga relaxation showed significant difference in anxiety score for pain versus alprazolam and placebo (P < 0.0001 for both). Ten minutes after RCT, the change from baseline in mean anxiety score for pain was significantly different with yogic relaxation (versus alprazolam [P = 0.043]; versus placebo [P = 0.002]). As per the global assessment of efficacy, the response was excellent in 9 (90%), 2 (20%), and 1 (10%) patients in yoga relaxation group, alprazolam group, and placebo group, respectively. Difference in response between three groups was significant (P < 0.0001). There was no significant difference in the global assessment of tolerability between three groups (P = 0.535). No adverse events were reported.

Conclusion:

Before RCT, YRT is an effective alternative to anxiolytic agents, alprazolam.

Factors Influencing Pain and Anxiety Before Endodontic Treatment: A Cross-Sectional Study Amongst American Individuals

Objective:

The present study aimed to assess preoperative levels of patient anxiety and pain before root canal treatment, and to explore variables that may affect these levels.

Methods:

Ninety-five patients presenting for an endodontic visit were recruited for the study. A questionnaire was administered. Visual analog scales were used to record levels of pain and anxiety. Data was tabulated, and analysis was performed using the Pearson Chi-Squire test with continuity correction, and the level of significance was set at 0.05 (P=0.05).

Results:

Anxiety was detected more frequently in females (60%) than in males (33%) (P=0.016). Sixty-two percent of patients who were waiting for a new treatment were anxious, compared to 39% of those who were returning to continue treatment (P=0.049). Sixty-nine percent of patients in pain reported being anxious (P=0.015). Patients aged 18–30 years reported more pain than those older than 30 years (P=0.023). Forty-three percent of new patients reported being in pain, whereas only 20% of patients returning for a treatment reported pain (P=0.027).

Conclusion:

Anxiety associated with root canal treatment is prevalent, and it was reported primarily by young females who were presenting for a new treatment. Pain and anxiety are highly inter-related, and they are usually reduced after the first endodontic session.

PRICE 2020 guidelines for reporting case reports in Endodontics: explanation and elaboration

Case reports play a key role in showcasing new, unusual or rare disease(s), and the impact of newer therapeutic approaches or interventions. The Preferred Reporting Items for Case reports in Endodontics (PRICE) 2020 guidelines are being introduced exclusively for Endodontics by adapting and integrating the CAse REport (CARE) guidelines and Clinical and Laboratory Images in Publications principles. The PRICE 2020 guidelines have been developed to help authors improve the completeness, accuracy and transparency of case reports in Endodontics and thus enhance the standard of manuscripts submitted for publication. The aim of this document is to provide a comprehensive explanation for each item in the PRICE 2020 checklist along with examples from the literature that demonstrate compliance with these guidelines. This information will highlight the importance of each item and provide practical examples to help authors understand the necessity of providing comprehensive information when preparing case reports. A link to this PRICE 2020 explanation and elaboration document is available on the Preferred Reporting Items for study Designs in Endodontology website at http://www.pride-endodonticguidelines.org.

Fear and Anxiety Pathways Associated with Root Canal Treatments Amongst a Population of East Asian Origin

Objective

This study aimed to identify and compare the pathways of endodontic fear and anxiety amongst East Asian origin patients attending Griffith University's Dental Clinics, Gold Coast, Australia.

Methods

East Asian patients who attended the Griffith University dental clinics were included in this study. The "My Endodontic Fear" survey was used. The pathways involved in self-perception of dental fear and anxiety were assessed through 5 different questions. Chi-square test was for statistical analysis and the level of significance was set at P<0.05.

Results

One hundred and forty six participants (n=146) (ages 18-62 years) of East Asian descent met the criteria to participate. 58.2% were females, and 41.8% males. The ethnicities were split into Chinese origin and non-Chinese origin (Korean, Phillipino, Japanese, Vietnamese). Results indicate multiple pathways affect the origin of fear, regardless of ethnicity. The Cognitive Conditioning pathway was the primary pathway selected by the Chinese and non-Chinese sub groups (51.4%, 43.6%) followed by the Informative (38.3%, 38.5%), then Vicarious (27.1%, 33.3%) and Parental (18.7%, 33.3%) pathways respectively.The Verbal Threat pathway was the least selected pathway for both groups, however the non- Chinese group selected this pathway significantly more often than the Chinese group (P<0.001).

Conclusion

This study demonstrates that the Cognitive Conditioning pathway was the primary fear and anxiety pathway utilized by both East Asian sub-groups. Understanding how patients develop fear and anxiety can help treating dentists discuss triggering factors for patients and alleviate undue anxiety prior to treatment.

Influence of culture change on the perception of fear and anxiety pathways in Endodontics: A pilot proof of concept study

This study assessed the influence of cultural changes (known as acculturation) on pathways of fear and anxiety in Endodontics. A purposive sampling technique identified patients of Saudi Arabian descent living in Australia and Saudi Arabia. Only patients with root canal fillings (or treatment planned for endodontic treatment) were included. Patients with intellectual disabilities, surgical root therapy, and aged under 20 were excluded. Consenting patients attending the dental clinics of University of Griffith University, Australia and University of Dammam, Saudi Arabia completed the "My Endodontic Fear Questionnaire." Three hundred and twenty-four patients (21-75 years) were included, 90% of participants reported more than one pathway. Australian Saudi Arabians mainly utilised vicarious pathway (94.9%), whilst Saudi Arabians utilised the verbal threat (93.5%) and parental pathway (78.3%). This study highlights the possible role of acculturation on the perception of fear and anxiety in Endodontics; however, further research with other ethnic groups is essential to enhance our understanding.