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Kovács SD. Suggestion for Determining Treatment Strategies in Dental Ethics. JOURNAL OF BIOETHICAL INQUIRY 2023:10.1007/s11673-023-10310-2. [PMID: 38032445 DOI: 10.1007/s11673-023-10310-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/01/2023] [Indexed: 12/01/2023]
Abstract
Contemporary medicine views health as the individual's physical, mental, and social well-being. Oral health plays a crucial role in one's well-being, as the oral cavity and its surrounding regions execute essential functions in verbal and nonverbal communication, sensing, digestion, and significantly contribute to aesthetic appearance. The multifaceted nature of the notion of oral health, as well as the patient's needs and autonomous will result in various treatment options for the same oral state, favouring often contrasting ethical values and different aspects of oral health. The objective of this article is to suggest alternative treatment strategies in dentistry with respect to the following factors: extent of rehabilitation, preserving one's anatomical structures, aesthetic outcome, number of sessions, patient autonomy. Additionally, this article describes the suggested treatment strategies in an ethical context and determines the conditions of their employment. The suggested treatment strategies are divided in two categories, extensive treatment strategies focusing on the patient's entire craniofacial complex, while specific treatment strategies focus on specific paramount issues.
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Affiliation(s)
- Szilárd D Kovács
- Institute of Behavioural Sciences, Semmelweis University, Budapest, 1089, Hungary.
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Bulmer JA, Currell SD, Peters CI, Peters OA. Endodontic knowledge, attitudes and referral patterns in Australian general dentists. Aust Dent J 2022; 67 Suppl 1:S24-S30. [PMID: 35505612 PMCID: PMC9795975 DOI: 10.1111/adj.12912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND General dental practitioners often perceive root canal treatments as complex, and specialist referrals are commonplace in general dental practice. Therefore, the aim of this study was to better understand the knowledge of Australian general dentists and their attitudes regarding endodontics in general, and specifically (RCT), to highlight barriers and facilitating factors in the provision of endodontic care. METHODS A combined paper-based and online survey was sent to general dental practitioners. The questionnaire consisted of 27 items, presented as checkboxes and in Likert scale format. Responses were tabled and statistically contrasted using Chi-square tests and linear regression analysis. RESULTS A significant proportion of surveyed dentists were not confident in their ability to provide endodontic care, specifically root canal treatments (RCT). Confidence depended on factors, such as time in practice, participation in continuing professional development as well as fear of litigation and type of treatment. Other factors such as the availability of appropriate instruments and referral options, had comparatively little impact on practitioner confidence. DISCUSSION While almost all general dental practitioners (GDPs) surveyed in this study believe RCT is important for improving the long-term retention of a tooth, just over half of the GDPs say they feel confident in their knowledge and provision of root canal treatment procedures.
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Affiliation(s)
- JA Bulmer
- Private PracticeGold CoastQueenslandAustralia
| | - SD Currell
- Private PracticeGold CoastQueenslandAustralia
| | - CI Peters
- School of DentistryThe University of QueenslandHerstonQueenslandAustralia
| | - OA Peters
- School of DentistryThe University of QueenslandHerstonQueenslandAustralia
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Outcome of Initial Endodontic Treatment Performed, by One Specialist, in 122 Tunisian Patients: A Retrospective Study. Int J Dent 2018; 2018:3504245. [PMID: 30154847 PMCID: PMC6091415 DOI: 10.1155/2018/3504245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/11/2018] [Indexed: 01/09/2023] Open
Abstract
Objective To assess the 6- to 24-month outcome of endodontic treatments performed, by one specialist, and to identify prognostic factors that may influence initial endodontic treatment outcome (IETO). Methods One hundred and forty-six patients out of 163 were included. A number of 201 teeth were endodontically treated, and an overall number of 408 canals were obturated. Of these, 165 teeth received initial endodontic treatment (IET). The criteria of the European Society of Endodontology were used to assess the IETO. The level of significance was set at p < 0.05%. Results Apical periodontitis (AP) was present in 42.5% of all cases, with a PAI >3 in 28.5%. The success rate (SR) was 91.5%. It was significantly higher in vital teeth (97%) than in devital teeth (87.7%) (p=0.04); however, a lower SR was recorded in teeth with AP (p=0.02). The lesion healed in 60 teeth (85.7%), decreased in size in 4 teeth (5.7%), and increased in size in 6 teeth (8.5%). A higher SR was obtained when a permanent restoration was present (94%) than absent (68.7%) (p=0.005). Conclusion Within the limitations of the study, pulp and periapical status and permanent restoration are found to be strong outcome predictors.
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3D imaging, 3D printing and 3D virtual planning in endodontics. Clin Oral Investig 2018; 22:641-654. [DOI: 10.1007/s00784-018-2338-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 01/07/2018] [Indexed: 01/22/2023]
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Abstract
Specialisation in endodontics allows for endodontic referrals by general dental practitioner (GDPs) and the study of factors influencing referral. These centre on a triad consisting of the referral process, non-clinical and clinical reasons for referral. Many non-clinical factors have been identified which may influence the referral process to the endodontist. A systematic review study was undertaken into the main non-clinical factors influencing endodontic referral by general dental practitioners to endodontists. Such awareness and appreciation of these factors benefits the commercial aspect of the referral practice, increases access by reducing barriers to care, and ultimately improves patient care. A literature search yielded three papers that met the eligibility criteria. All studies included were cross sectional survey studies completed by GDPs. The main non-clinical factors seen from the studies include: Availability. Personality, relationships and communication. LOCATION Availability presented as a common thread throughout all the studies. In conclusion, endodontic referral is multifactorial and influenced by several factors, that are not related to the nature of the endodontic disease, and this is a dynamic process. Due to the lack of high level studies, and limitations of the available studies, further research is suggested into the relevant area of non-clinical endodontic factors for endodontic referral and thus allowing for further analysis.
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Sonntag D, Martin E, Raab WHM. Representative survey on the reprocessing of endodontic instruments in Germany. Br Dent J 2016; 220:465-9. [DOI: 10.1038/sj.bdj.2016.333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2016] [Indexed: 11/10/2022]
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Nason K, Donnelly A, Duncan HF. YouTube as a patient-information source for root canal treatment. Int Endod J 2015; 49:1194-1200. [DOI: 10.1111/iej.12575] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 11/03/2015] [Indexed: 11/26/2022]
Affiliation(s)
- K. Nason
- Division of Restorative Dentistry & Periodontology; Dublin Dental University Hospital; Trinity College Dublin; Dublin Ireland
| | - A. Donnelly
- Division of Restorative Dentistry & Periodontology; Dublin Dental University Hospital; Trinity College Dublin; Dublin Ireland
| | - H. F. Duncan
- Division of Restorative Dentistry & Periodontology; Dublin Dental University Hospital; Trinity College Dublin; Dublin Ireland
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Ghotane SG, Al-Haboubi M, Kendall N, Robertson C, Gallagher JE. Dentists with enhanced skills (Special Interest) in Endodontics: gatekeepers views in London. BMC Oral Health 2015; 15:110. [PMID: 26391673 PMCID: PMC4578425 DOI: 10.1186/s12903-015-0085-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 08/14/2015] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Dentists with a special interest hold enhanced skills enabling them to treat cases of intermediate complexity. The aim of this study was to explore primary dental care practitioners' views of dentists with a special interest (DwSIs) in Endodontics in London, with reference to an educational and service initiative established by (the former) London Deanery in conjunction with the NHS. METHODS A cross-sectional postal survey of primary care dentists working across different models of care within London was conducted, with a target to achieve views of at least 5 % of London's dentists. The questionnaire instrument was informed by qualitative research and the dental literature and piloted prior to distribution; data were analysed using SPSS v19 and STATA v12.0. RESULTS Six per cent of London's primary care dentists (n = 243) responded to the survey; 53 % were male. Just over one third (37 %; n = 90) were aware of the DwSI service being provided. Most practitioners reported that having access to a DwSI in Endodontics would support the care of their patients (89 %; n = 215), would carry out more endodontic treatment in the NHS primary dental care if adequately reimbursed (93 %; n = 220), and had more time (76 %; n = 180). Female respondents appeared to be less confident in doing endodontic treatment (p = 0.001). More recently qualified respondents reported greater need for training/support for performing more endodontic treatment in the NHS primary dental care (p = 0.001), were more dissatisfied with access to endodontic service in the NHS primary dental care (p = 0.007) and more interested to train as a DwSI in endodontics (p = 0.001) compared with respondents having a greater number of years of clinical experience since qualification. CONCLUSION The findings lend support to the concept of developing dentists with enhanced skills as well as ensuring additional funding, time and support to facilitate more routine endodontics through the NHS primary care to meet patient needs. More recently qualified dentists working in London were more concerned regarding endodontic service access, expressed need for training/support for undertaking more endodontic treatment in the NHS primary dental care and a desire to train as a DwSI in endodontics.
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Affiliation(s)
- Swapnil G Ghotane
- King's College London Dental Institute at Guy's, King's College and St Thomas's Hospitals, Division of Population and Patient Health, Denmark Hill Campus, Bessemer Road, London, SE5 9RS, UK.
| | - Mustafa Al-Haboubi
- Faculty of Education & Health, University of Greenwich, Avery Hill Road, London, SE9 2UG, UK.
| | - Nick Kendall
- NHS South West London and NHS London, based at Public Health Directorate, Floor 13, Leon House, 233 High Street, Croydon, CR9 1XT, UK.
| | | | - Jennifer E Gallagher
- King's College London Dental Institute at Guy's, King's College and St Thomas's Hospitals, Division of Population and Patient Health, Denmark Hill Campus, Bessemer Road, London, SE5 9RS, UK.
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Neukermans M, Vanobbergen J, De Bruyne M, Meire M, De Moor RJG. Endodontic performance by Flemish dentists: have they evolved? Int Endod J 2014; 48:1112-21. [DOI: 10.1111/iej.12409] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 11/04/2014] [Indexed: 11/28/2022]
Affiliation(s)
- M. Neukermans
- Department of Restorative Dentistry and Endodontology; Dental School; Ghent University; Gent Belgium
- BEL Defense; Medical Component Dental Command; Evere Belgium
| | - J. Vanobbergen
- Department of Community Dentistry and Oral Public Health; Dental School; Ghent University; Gent Belgium
| | - M. De Bruyne
- Department of Restorative Dentistry and Endodontology; Dental School; Ghent University; Gent Belgium
| | - M. Meire
- Department of Restorative Dentistry and Endodontology; Dental School; Ghent University; Gent Belgium
| | - R. J. G. De Moor
- Department of Restorative Dentistry and Endodontology; Dental School; Ghent University; Gent Belgium
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Kim S. Prevalence of referral reasons and clinical symptoms for endodontic referrals. Restor Dent Endod 2014; 39:210-4. [PMID: 25110645 PMCID: PMC4125585 DOI: 10.5395/rde.2014.39.3.210] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 05/13/2014] [Indexed: 11/24/2022] Open
Abstract
Objectives To investigate the prevalence of different primary reasons for endodontic referrals and the clinical symptoms of the referred cases. Materials and Methods Clinical data of total endodontic treatment cases (1,014 teeth) including endodontic referral cases (224 teeth) between January 1, 2010 and December 31, 2012, at Kangdong Sacred Heart Hospital, were investigated retrospectively. The one major reason for referral, the clinical symptoms, and the resulting treatment procedures of referral cases were recorded. The percentages of clinical symptoms of the endodontic referral cases and the total endodontic treatment cases were compared by χ2 test for each symptom. Results Persistent pain was the most frequent reason for endodontic referral (29.5%), followed by presence of gingival swelling and sinus tract (24.1%), and apical radiolucency (12.9%). Referrals in cases involving endodontic difficulties such as canal calcification, broken instruments, post, perforation, and resorption were less than 5.0%, respectively. The percentages of four major clinical symptoms of pain, apical radiolucency, previous endodontic treatment, and gingival swelling and sinus tract were significantly higher in the endodontic referral cases than those in the total endodontic cases (p = 0.001). Among the included referral cases, 72.8% were treated with nonsurgical endodontic treatment only. Teeth other than the referred teeth were diagnosed as the origin of the problem in 5.8% of the referrals. Conclusions The high prevalence of pain, apical radiolucency, previous treatment, and gingival swelling and sinus tract in endodontic referral cases suggest that these symptoms may be what general practitioners consider to be difficult and refer to endodontists.
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Affiliation(s)
- Seonah Kim
- Department of Dentistry, Lin Women's Hospital, Seoul, Korea
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Celeste RK, Moura FRRD, Santos CP, Tovo MF. Análise da produção ambulatorial em municípios com e sem centros de especialidades odontológicas no Brasil em 2010. CAD SAUDE PUBLICA 2014; 30:511-21. [DOI: 10.1590/0102-311x00011913] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 09/27/2013] [Indexed: 11/22/2022] Open
Abstract
O objetivo foi descrever a produção de serviços especializados em municípios brasileiros com e sem Centros de Especialidades Odontológicas (CEO) e estudar fatores associados. Para a coleta de dados, foram consultados: o Departamento de Informática do SUS, dados do Atlas de Desenvolvimento Humano do Brasil e do Instituto Brasileiro de Geografia e Estatística. Utilizou-se regressão binominal negativa inflada de zeros para modelar taxas de procedimentos de endodontia, atenção básica, periodontia e cirurgia. Após controle por fatores sociodemográficos, os municípios com CEO apresentaram taxas maiores do que os sem, exceto para taxas de atenção básica. No modelo final, com variáveis de estrutura dos serviços, os municípios com CEO do tipo III tiveram uma taxa de procedimentos de endodontia 2,08 (IC95%: 1,26; 3,44) vezes maior que sem CEO. Das variáveis de estrutura, mais gastos em saúde e maiores taxas de dentistas no SUS estavam consistentemente associados a maiores taxas de quaisquer procedimentos. Os CEO parecem ter um efeito positivo na produção municipal de procedimentos especializados, particularmente para a taxa de procedimentos de endodontia, e esse efeito não é explicado por variáveis de estrutura.
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Gupta R, Rai R. The adoption of new endodontic technology by Indian dental practitioners: a questionnaire survey. J Clin Diagn Res 2013; 7:2610-4. [PMID: 24392420 PMCID: PMC3879893 DOI: 10.7860/jcdr/2013/5817.3628] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 08/19/2013] [Indexed: 11/24/2022]
Abstract
AIM To ascertain the adoption of new endodontic technology in general dental practice in India in 2011. METHODOLOGY A postal questionnaire survey comprising 26 questions was sent to 700 general dental practitioners. The questions covered professional activity, root canal preparation and instrumentation, choice of irrigants and intracanal medicaments, choice of obturation techniques and other aspects of endodontics. The data were analyzed using descriptive statistics and the Chi-square (χ(2)) test at 0.05 level of significance. RESULTS The overall response rate was 88%. The results showed that rubber dams were used by 27% of dental practitioners in India. The most widely used irrigant was sodium hypochlorite, which was used by 33% of the respondents. Thirty nine percent of the practitioners were still incorporating only hand files during the cleaning and shaping phase of treatment. The technique of choice was both step back and crown down (35%). Calcium hydroxide was found to be the most frequently used (62%) intracanal medicament. Lateral condensation with guttapercha (61%) was the most common method used for obturation. Majority used zinc oxide eugenol as a sealer (55%). The post obturation restoration was done mostly by composite material (46%). Most of the respondents placed crowns after root canal treatment. Digital radiography was reported as being used by 17% of the respondents. There was no difference between males and females with respect to the incorporation of new technologies in dentistry. They had been incorporated significantly more by respondents who held postgraduate qualifications and had professional activities of <5 years. CONCLUSION The results indicated that new endodontic technology and materials are slowly being incorporated in clinical practice of endodontics in India. This survey shows the importance of continuing dental education for practitioners to update their knowledge.
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Affiliation(s)
- Ruchi Gupta
- Reader, Department of Conservative Dentistry & Endodontics, Institute of Dental Studies & Technologies, Delhi-Meerut Road, Kadrabad, Modinagar, Uttar Pradesh-201201, India
| | - Rochna Rai
- Department of Conservative Dentistry & Endodontics, Institute of Dental Studies & Technologies, Delhi-Meerut Road, Kadrabad, Modinagar, Uttar Pradesh-201201, India
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Motearefi P, Abbott PV. A study of the endodontic workforce in Australia in 2010. Int Endod J 2013; 47:477-86. [DOI: 10.1111/iej.12174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 07/16/2013] [Indexed: 11/30/2022]
Affiliation(s)
- P. Motearefi
- School of Dentistry; University of Western Australia; Nedlands WA Australia
| | - P. V. Abbott
- School of Dentistry; University of Western Australia; Nedlands WA Australia
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Abstract
This review highlights current issues in the provision of restorative dentistry both in primary and secondary care settings. Current challenges in the provision of restorative procedures are reviewed and methods in improving care and efficiency are proposed. Possible changes to the infrastructure and delivery of care are suggested in order to improve effectiveness and the patient pathway.
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