Reasons for patients opting out from root canal treatment and preferring extraction in a prospective study

Abhinav Kumar Singh

doi:10.4103/ijmo.ijmo_19_22

ORIGINAL ARTICLE

Year : 2022 | Volume : 7 | Issue : 2 | Page : 36-38

Reasons for patients opting out from root canal treatment and preferring extraction in a prospective study

Abhinav Kumar Singh
Professor, Department of Conservative Dentistry and Endodontics, Buddha Institute of Dental Science and Hospital, Patna, Bihar, India

Date of Submission	07-Dec-2022
Date of Acceptance	11-Dec-2022
Date of Web Publication	30-Dec-2022

Correspondence Address:
Dr. Abhinav Kumar Singh
Department of Conservative Dentistry and Endodontics, Buddha Institute of Dental Science and Hospital, Patna - 800 020, Bihar
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijmo.ijmo_19_22

Abstract

Background: Unfortunately, endodontic care has a bad reputation. To effectively address the problem, it is vital to identify the elements that cause patients' discomfort and so prevent them from participating in RCT. Aim and Objectives: The goal of this study is to assess the factors that lead people from southern India to forego root canal treatment (RCT) in favor of tooth extraction. Methodology: 500 patients who sought therapy for irreversible pulpitis at the department of conservative dentistry and endodontics and ultimately opted for extraction were analyzed. Patients were contacted, and their completed surveys were gathered. To conduct statistical analysis, the recorded explanations were put into SPSS (Statistical Package for the Social Sciences). Frequency distribution tests were performed on the data. Results: Twenty percentage of patients in the study reported that they did not want to undergo RCT because they believed it would be ineffective, while 15% cited the high cost of RCT and a crown as a deterrent. Twenty-five percentage of respondents said they needed pain relief immediately but were unconcerned about tooth loss. Conclusion: Patient misconceptions about the efficacy of RCTs were a major factor in their decision to forego participation in these studies in favor of extraction.

Keywords: Dental anxiety, endodontics, patient counseling, patient education, patient preferences, planning, root canal treatment, tooth extraction

How to cite this article:
Singh AK. Reasons for patients opting out from root canal treatment and preferring extraction in a prospective study. Int J Med Oral Res 2022;7:36-8

How to cite this URL:
Singh AK. Reasons for patients opting out from root canal treatment and preferring extraction in a prospective study. Int J Med Oral Res [serial online] 2022 [cited 2023 May 28];7:36-8. Available from: http://www.ijmorweb.com/text.asp?2022/7/2/36/366312

Introduction

To prevent and cure pulpal and periradicular pathosis and to preserve the cleaned tooth from further microbial entrapment, endodontic therapy, also known as root canal treatment (RCT), involves the removal of the damaged pulpal tissue. When an infected or injured tooth develops persistent pupal pathosis, an endodontist will perform a root trench procedure to save the tooth. According to the American Association of Endodontists, root canal therapy, or “root trench,” is responsible for saving an estimated 40 million teeth annually in the United States. Root canal therapy and tooth extraction are the usual methods of dealing with infections of the root pulp. Root canal treatment has improved in recent years, and now has a success rate of around 95% in salvaging a natural tooth.^[1],[2] Even though RCT has been shown to boost success rates, some patients still choose to have teeth extracted instead. This results in the loss of a tooth, which in turn causes other teeth to get damaged or fall out due to a collapsed occlusion and a poorly fitting prosthesis.^[3],[4] To effectively address the problem, it is crucial to identify the elements that cause patients' discomfort and consequently prevent them from participating in RCT. This research aimed to better understand why so many people in the South Indian population choose to have their teeth extracted rather than undergo root canal therapy.

Methodology

The research included 500 patients from the outpatient department who met the inclusion and exclusion criteria. The dental hospital's rationale for the patient's decision to decline participation in the RCT was measured using a self-administered questionnaire that had been piloted in advance. After obtaining verbal agreement from patients, questionnaires were sent to their homes, filled out, and returned in business reply envelopes before being recorded and analyzed statistically. All procedures performed in the study were conducted in accordance with the ethics standards given in 1964 Declaration of Helsinki, as revised in 2013. The study proposal was submitted for approval and clearance was obtained from the ethical committee of our institution. A written informed consent was obtained from each participant.

Inclusion criteria

Patient having dental caries with symptoms of irreversible pulpitis
Fully erupted teeth
Teeth with restorable prognosis.

Exclusion criteria

3^rd molars, not fully erupted teeth
Tooth with grade III, II Mobility
Radiographically extensive bone loss
Medically compromised patients
Patients having trismus
Teeth that cannot be restored.

Results

The distribution of patients according to reasons to drop out of RCT is presented in [Graph 1]. Among the patients, 20% of patients felt that the RCT is a failure treatment, 5% of patients felt that the tooth needs to be extracted after RCT, 2% of patients felt that RCT will cause cancer and other health issues, 15% of patients felt that the cost of RCT and crown was high, 10% of patients felt that compromised prognosis was given by the dentist, 25% of patients felt that they require immediate pain relief but not worried about tooth loss, 2% of patients felt they cannot be cooperative and prolonged treatment periods, 4% of patients felt that they are too old for RCT and requesting extraction, and 17% of patients felt that they had previous bad experience from RCT.”

Discussion

Worries about the length of time and severity of discomfort experienced during endodontic treatment are common among patients.^{[5],[6],[7],[8],[9],[10]} Dentists, especially those treating patients who present with preoperative symptoms, often express anxiety and worry about their patients' ability to handle the pain of RCT.^[11] Preventing pain, interacting positively, offering encouraging words, and giving the patient a sense of agency are all crucial elements in creating a positive setting for endodontic treatment. Fear of the dentist can take many forms, but dental phobia is the most extreme.^[12],[14] The findings showed that those who suffered from dental anxiety were more likely to be edentulous and that those who were dentate had more missing and fewer filled teeth. Dentate patients with dental phobia were, therefore, more likely to need prosthodontic therapy.^[10] Anxiety and fear of discomfort might cause patients to avoid RCT, which can lead to the need for tooth extractions down the road. Around 3.03% of patients dropped out of the RCT because they were concerned about missing too much work to go to the clinic for repeated sessions over a lengthy period of time. They also believe that elderly patients, transportation, and spectator accommodations are overburdened. Orthostatic hypertension aggravates the symptoms of some systemic illnesses such as Parkinson's disease. Reasons included high prices and lengthy recoveries. In these situations, the use of neck and back support devices during brief in-office visits increases confidence in the treatment's eventual effectiveness. Even though there have been improvements in the way dental operations are carried out and techniques of pain management, most patients still perceive going to the dentist as a difficult and unpleasant experience, and only around 4.09% participated in RCT.^{[5],[6],[7],[8],[9],[10]} Subjective patient perceptions of the procedure's benefits and risks are overridden by subjective considerations of individual patients' psychological traits and the potential for a negative experience. As a result, both worry and pain tend to mount.^[9],[15] The trust of patients may be earned through competent esthetic and pain treatment, as well as through reassuring words. Extraction of one or two posterior teeth, patients said, had little to no functional consequences. As a result of the patient's view that the loss of one or two rear teeth may have little to no impact on their quality of life (QOL) or appearance, endodontic treatment of molars is more costly than that of front teeth. When it comes to chewing, preserving the arch, and proper occlusion, the patient's dentist should fill them in on the significance of the back teeth. The elements related to patients' health, teeth, and dentist that might account for a successful RCT are analyzed in depth in a literature review conducted by Estrela et al.^[4] A recent research by Yamaguchi et al.^[6] identifies all the potential causes of root canal failures, providing dentists with the knowledge they need to minimize the aforementioned causes, and increase the success rate of RCTs. “Radiographic interpretation” is giving way to “disease visualization” in the dental field. Due to these ground-breaking advancements, the long-term success of RCTs is both greater and more predictable than ever before. Extraction of teeth that have undergone endodontic treatment is often done for cosmetic reasons, according to a single study. For endodontic therapy to be successful, the irrigant must be delivered to the site of infection, agitated there, and then removed. Methods for agitating irrigant and their debridement effectiveness are summarized in this systematic study. Because of the potential financial and emotional costs, neither the dentist nor the patient wants to take the chance that there is a problem tooth hiding behind the prosthesis. Improved uptake of RCTs is possible with meticulous treatment design and administration.

Conclusion

As a result of our research, dentists and specialists will be better able to tailor their treatment programs to the specific requirements of their patients. Many teeth may be preserved by undergoing RCT rather than extraction after carefully considering the causes and the requirements of the patients, resulting in a high QOL and the maintenance of natural dentition.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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