Retreatment in endodontics: treatment decisions by general practitioners and dental teachers in Finland

Abstract

To evaluate treatment decisions of general practitioners (GPs) and dental teachers (DTs) in cases of endodontically treated teeth and to test the hypothesis that dentists' treatment decisions are independent of their working sector and other practice characteristics. A questionnaire based on four endodontic cases was mailed to 400 GPs and 47 DTs. The GPs were selected by stratified randomisation by gender, and main occupation (public and private sector). Others were all full-time DTs, representing clinical disciplines other than surgery and orthodontics. The endodontic cases were described in detail: one with a radiograph enclosed, three with statements on radiographic examinations. For each case, respondents chose the optimal treatment from alternatives, later reclassified as 'no therapy now' (further examination within 3-12 months), and 'active treatment' (immediate retreatment or periapical surgery). For Case 1 (tooth 25, asymptomatic, in normal occlusion, the radiograph revealed an underfilled root canal and a crown with a post, widened periodontal ligament space around the apex but no radiolucency), active treatment was chosen more frequently by private than by public dentists (11% vs. 4%, P=0.01), but neither sector differed (P>0.05) from DTs (6%). Decisions in favour of active treatment were associated with higher share of adult patients (OR=2.8; 95%CI: 0.3, 1.0; P=0.01). Cases 2-4 showed no difference in treatment decisions by practice characteristics. Treatment decisions by GPs and DTs were quite similar for each case and in most cases independent of the dentist's work and practice related characteristics.