Endodontic follow-up practices, sources of knowledge, and self-assessed treatment outcome among general dental practitioners in Sweden and Norway

Dentists' knowledge of non-surgical root canal treatment, a systematic review

OBJECTIVES

Dental practice is based upon dentists' cognitions, knowledge being foundational. Knowledge is attained through education and perception. Although knowledge is modulated by beliefs, attitudes, preferences, and behaviors, it is essential to evidence-based practice. Cross-sectional studies uniformly demonstrate that community NSRCT is of sub-optimal quality worldwide, is lack of knowledge a problem? Our purpose was to measure dentists' knowledge of root canal treatment (NSRCT).

DATA

Quantitative and qualitative data were extracted: purpose, topics assessed, authors cited knowledge sources, number of dentists studied, number of questions, authors descriptors of knowledge level,% correct answers by question, authors recommendations.

SOURCES

OVID Medline, EMBASE, Web of Science, and hand-searching.

STUDY SELECTION

Studies which had measured dentists' knowledge of non-surgical root canal treatment that was valuable, reliable, and had practical implications which could be implemented. A total of 51 papers from 19 countries measured the knowledge of 15,580 dentists using 445 questions on 29 root canal treatment topics.

CONCLUSIONS

'Gold standards' were from literature, external bodies, or expert consensus in 47, 31, and 2 papers respectively. Levels of knowledge by percentage correct answers among studies were poor to moderate and varied considerably. The mean, for the 50 studies where overall study percentages could be calculated, was 57 %, standard deviation 17 %, and a range of 16 % to 82 %. Authors' adjectives describing knowledge levels were generally negative. Additional education was advised in 49 papers, but without evidence that education was inadequate; 6 papers recommended increased use of protocols; only 5 papers advocated research on the cause of lack of knowledge.

CLINICAL SIGNIFICANCE

Dentists' root canal treatment knowledge was found to be poor to moderate, as well variable. This may constrain quality of care. However, provision of information without attention to dentists' cognitions and motivations may not be successful. Educational strategies and goals should be re-evaluated. Evidence-based practice faces many barriers.

How do we and how should we deal with uncertainty in Endodontics?

In many clinical cases a dentist may feel certain when for example diagnosing, deciding on treatment, or assessing the prognosis—in other cases many dentists may feel a degree of doubt or uncertainty. This paper aims to explore the philosophical concept of uncertainty and its different dimensions, using the condition “persistent apical periodontitis associated with a previously root filled tooth” as an example. Acknowledging that uncertainty exists in any clinical situation can be perceived as uncomfortable, as some might regard it as a weakness. Whilst some types of uncertainty met in dental practice can be addressed and reduced, there are other types which are inevitable and must be accepted. To make sound decisions, it is pertinent that the dentist reflects on and values the consequences of uncertainty. In this paper, a conceptual model is presented by which the dentist can identify the type of uncertainty in a clinical case, making it possible to decide on a strategy on how to manage the uncertainty and its possible consequences, with the aim to support the dentist's care for their patients. The understanding that uncertainty exists and the ability to acknowledge and be comfortable with it when making decisions should be addressed throughout our professional career, and thus ought to be developed during undergraduate education. Some suggestions on how teachers could target this are given in the paper.

Effects of an individualized training course on technical quality and periapical status of teeth treated endodontically by dentists in the Public Dental Service in Norway: An observational intervention study

AIM

To investigate the effect of a continuing education course on technical quality and treatment outcome for root filled permanent teeth in Møre and Romsdal County, Norway.

METHODOLOGY

Fifty-two dentists employed in the Public Dental Service in Møre and Romsdal county, Norway, completed a two-day continuing education course in root canal treatment. Periapical radiographs of root filled teeth treated before and after the course, with at least one-year follow-up were identified and scored for technical quality and periapical status. Technical root filling quality was assessed by density and length and the treatment outcome by PAI scores. Treatment information was achieved from the county's electronic dental record system. Information regarding the dental practitioners' background and treatment procedure routines was collected by a questionnaire. Descriptive statistics analyses and mixed-effect logistic regression analyses were performed to evaluate the effect of the course.

RESULTS

Radiographs were available for 224 teeth root filled before and for 221 teeth after the course. The proportion of teeth with adequate root filling quality was significantly lower after the course (p = .006), associated mainly with short root fillings (p < .001). No significant differences were observed in treatment outcome. There were, however, large differences in treatment outcome amongst subgroups of dentists. Further, there was evidence of effect modification by the continuing education course on periapical outcome by patient's age (p_interaction  = .0023) suggesting that teeth in patients ≤18 years healed relatively better post-course compared to patients >18 years.

CONCLUSIONS

A two-day continuing education course in root canal treatment attended by Public Dental Service dentists in Norway did not improve the technical quality of root fillings or periapical status associated with root filled teeth.

Effects of an individualised training course in endodontics on the knowledge and insights of dentists in Public Dental Service in Norway

OBJECTIVE

To evaluate the knowledge and insights of general dental practitioners regarding endodontic diagnosis and treatment principles before and after attending a 2-days continuing education course.

MATERIALS AND METHODS

Sixty-seven dentists employed in the Public Dental Service in Møre and Romsdal county, Norway, were invited to a continuing education course in endodontics. Before and after the course, they answered a questionnaire weighing the importance of factors influencing the prognosis of endodontic treatment. The same questionnaire was answered by specialists in endodontics (n = 56; Spec Group) and a reference group consisting of general dental practitioners from both private and public practice (n = 21; Ref Group). The Test Group answered both before and after the course, while the Spec and Ref Groups completed the questionnaire once. The responses were compared using the Wilcoxon Sign test and Mann-Whitey U test.

RESULTS

Of the 67 dentists in the Test Group, 49 (73%) completed the course and answered both questionnaires. Before attending the course, the Test Group differed significantly from the Spec Group in 18 out of 27 prognostic factors (p ≤ .05). After the course, there was only moderate improvement in the Test Group responses. On only three factors, they agreed significantly more with the specialists than before attending the course (p ≤ .05). After the Test Group participants had attended the course, their responses were comparable to the responses of the Ref Group.

CONCLUSIONS

A two-days continuing education course only marginally improved dentists' level of knowledge and insights regarding the influence of prognostic factors in endodontics.