Can audit improve patient care and treatment outcomes in endodontics?

Quality of endodontic record-keeping and root canal obturation performed by final year undergraduate dental students: An audit during the COVID-19 pandemic

BACKGROUND

To assess the quality of endodontic record-keeping and root canal obturation performed by undergraduate final year dental students during the COVID-19 pandemic.

MATERIALS AND METHODS

Dental records and dental radiographs of patients who received endodontic treatments between March 2020 and March 2022 by undergraduate students during the COVID-19 pandemic were included. The audit data were collected based on the European Society of Endodontology guidelines retrospectively via assessing the patient's clinical records and intraoral periapical radiograph. Root canal obturation quality was evaluated based on the following parameters: adaptation, length, taper, and mishap. A root filling is defined as satisfactory only when all four parameters were graded as acceptable. Subsequently, the data were recorded and analysed using Chi-Square test with the level of significance set at p = 0.05.

RESULTS

A total of 111 patient records with 111 root canal-treated teeth were evaluated. The highest percentage of documented evidence was noted in the patient's general records, while the endodontic treatment records showed the lowest percentage of documented evidence. 78 (70.3%) of root canal-treated teeth were deemed satisfactory with acceptable adaptation, length, taper, and absence of mishap. Moreover, no statistical significance in terms of root canal filling quality was noted between anterior and posterior teeth, and between maxillary and mandibular arch.

CONCLUSIONS

Although patient records and root canal fillings quality were deemed satisfactory in most cases, strict documentation requirements and continuing dental education in audit training are necessary for quality assurance.

Patient record assessment of results and related resources spent during one year after initiation of root canal treatment in a Swedish public dental organisation

Aim

To document treatment outcomes and related resources, in patients undergoing root canal treatment (RCT) in county public dental clinics, by monitoring patient records for 12 months from treatment start.

Methodology

The subjects comprised 243 patients starting RCT at 20 public dental clinics in Västra Götaland county, Sweden. Their computerized dental records were monitored prospectively for a year after starting their endodontic treatment. Treatment was completed with either a root filling or extraction. The following treatment‐specific variables were registered: number of appointments and days until treatment was completed, possible complications and prescriptions for antibiotics, and for the root filled teeth: type of coronal restoration and further procedures undertaken within the year. The treatment outcomes were compared with the preoperative variables and in a logistic regression analysis.

Results

Complete data were available for 240 patients (98.8%): 128 women and 112 men, with a mean age of 48.5 years (SD = 16.3). Molar teeth predominated (n = 113, 47.1%). Most cases were completed with a root filling (n = 169, 70.4%). The remainder were extracted (n = 32, 13.3%) or were still uncompleted (n = 39, 16.3%). On average, a root filling was completed in 2.4 (SD = 0.9) appointments, or extraction at the third appointment (SD = 1.6). The molars were less often completed and often predominant among the extracted teeth. The indication for extraction was often for endodontic or RCT‐related reasons. Most complications were registered in the molars and antibiotics were prescribed in 20 cases. Most root filled teeth were restored with a direct restoration. Four root filled teeth (2.4%) were extracted within the time period.

Conclusions

Patient records, followed from the start of treatment, show that 12 months on, the root filling had not been completed in just under 30% of the teeth. Of these, about half were extracted. Of particular concern is the outcome for endodontic treatment of molar teeth. In the general practice setting, molar endodontics are not only technically challenging but also very demanding in terms of chairside resources. In the present study, a successful outcome was achieved in just over half the cases.

Is there a justification of conducting clinical audit in the endodontic treatment outcomes?

OBJECTIVE

The aim of this study is to determine the role of clinical audit in improving endodontic treatment outcomes.

MATERIALS AND METHODS

An audit at the department of endodontics at dental specialty centre kingdom of Saudi Arabia was carried out. The audit was conducted by developing endodontics treatment and success predictors based on evidence, that can be measured for endodontic care. A total of 12 months' data was examined from the previous dental records. Ten clinical cards were which included root canal treatment were selected. The audit was carried out for a minimum of 50 teeth and a maximum of 200 teeth. The radiographs of record cards were studied and a single dentist completed the audit tool.

RESULTS

The vitality test was performed in 1.98% cases, intra-canal medicament was used and named in 3.96% cases, 3.96% the teeth were extracted due to endodontic failure. Further, in 6.93% of the cases that were identified had certain spaces but overall root canal filling was evaluated as satisfactory.

CONCLUSION

The vitality test, type of intracanal medicament, and assessment of root canal filling were not done, but there was an overall performance of predictors for endodontic treatment.

The effectiveness of guideline implementation strategies in the dental setting: a systematic review

BACKGROUND

Guideline implementation has been an ongoing challenge in the dental practice setting. Despite this, there are no reviews summarising the existing evidence regarding effective guideline implementation strategies in this setting. In order to address this, this systematic review examines the effectiveness of guideline implementation strategies in the dental practice setting.

METHODS

A systematic search was undertaken according to the PRISMA statement across nine electronic databases, targeting randomised controlled trials and quasi-experimental studies which evaluated the effectiveness of guideline implementation strategies in improving guideline adherence in the dental setting. All records were independently examined for relevance and appraised for study quality by two authors, with consensus achieved by a third author. Data were extracted from included studies using a standardised data extraction pro forma.

RESULTS

A total of 15 records were eligible for inclusion in this review, which focused on the effects of audit and feedback, reminders, education, patient-mediated interventions, pay for performance and multifaceted interventions. Although there were some conflicting evidence, studies within each category of implementation strategy indicated a positive effect on guideline adherence.

CONCLUSIONS

This study has identified education, reminders and multifaceted interventions as effective implementation strategies for the dental practice setting. Although this is similar to research findings from other health sectors, there is some evidence to suggest patient-mediated interventions may be less effective and pay for performance may be more effective in the dental setting. These findings can inform policy makers, professional associations, colleges and organisations in the future adoption of clinical guidelines in the dental practice setting.

TRIAL REGISTRATION

This systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration ID CRD42018093023.

Clinical audit training improves undergraduates' performance in root canal therapy

AIM

To evaluate the effectiveness of clinical audit-feedback cycle as an educational tool in improving the technical quality of root canal therapy (RCT) and compliance with record keeping performed by dental undergraduates.

METHODS

Clinical audit learning was introduced in Year 3 of a 5-year curriculum for dental undergraduates. During classroom activities, students were briefed on clinical audit, selected their audit topics in groups of 5 or 6 students, and prepared and presented their audit protocols. One chosen topic was RCT, in which 3 different cohorts of Year 3 students conducted retrospective audits of patients' records in 2012, 2014 and 2015 for their compliance with recommended record keeping criteria and their performance in RCT. Students were trained by and calibrated against an endodontist (κ ≥ 0.8). After each audit, the findings were reported in class, and recommendations were made for improvement in performance of RCT and record keeping. Students' compliance with published guidelines was presented and their RCT performances in each year were compared using the chi-square test.

RESULTS

Overall compliance with of record keeping guidelines was 44.1% in 2012, 79.6% in 2014 and 94.6% in 2015 (P = .001). In the 2012 audit, acceptable extension, condensation and the absence of mishap were observed in 72.4, 75.7% and 91.5%; in the 2014 audit, 95.1%, 64.8% and 51.4%; and in 2015 audit, 96.4%, 82.1% and 92.8% of cases, respectively. In 2015, 76.8% of root canal fillings met all 3 technical quality criteria when compared to 48.6% in 2014 and 44.7% in 2012 (P = .001).

CONCLUSION

Clinical audit-feedback cycle is an effective educational tool for improving dental undergraduates' compliance with record keeping and performance in the technical quality of RCT.

Perceptions of single-visit and multiple-visit endodontic treatment: a survey of endodontic specialists and general dentists in Hong Kong

AIM

To study the preference of practice for single- and multiple-visit endodontic treatment by Hong Kong endodontists and general dental practitioners (GDPs), and to investigate their reasons for choosing single- or multiple-visit treatment in their practice.

METHOD

An anonymous questionnaire was mailed to all 16 registered endodontists and 800 randomly selected GDPs in Hong Kong to explore their preference and reasons for selecting single- or multiple-visit endodontic treatment for their patients. Information on the use of magnifying loupes, microscopes and the number of years they have been in dental practice was also collected.

RESULTS

Eight endodontists and 429 GDPs returned their questionnaires and the response rate was 50% and 53.6% respectively. Among the GDPs, 404 (94.2%) undertook endodontic treatment in their practices. For those performing endodontic treatment, the mean number of years of practice was 23.6 ± 4.8 for endodontists and 15.3 ± 9.1 for GDPs. Seven endodontists (87.5%) used a surgical microscope. For GDPs, only 25 (6.2%) used a surgical microscope and 123 (30.4%) used magnifying loupes during endodontic treatment. Seven endodontists (87.5%) and 375 GDPs (92.8%) predominantly performed multiple-visit treatment. The commonest reasons for choosing multiple-visit treatment for both endodontists and GDPs were the positive effects of interappointment medications (n = 3, 37.5%) and that the tooth to be treated had doubtful prognosis (n = 103, 25.5%). The commonest reason for choosing single-visit treatment for both endodontists and general dentists was that treatment could be completed in one visit (n = 4, 50%) and (n = 127, 31.4%).

CONCLUSION

Most Hong Kong endodontists and GDPs preferred offering multiple-visit endodontic treatment.