Root Canal Treatment for Older Adults: New Zealand Dentists' Experiences and Approach to Practice.

Aims: The aim of this study is to determine the use of rubber dams, magnification techniques, working length measurement methods, and preferences for multiple sessions among endodontists and general dental practitioners performing root canal treatment in Turkey, as well as to evaluate disinfection and obturation protocols. Methods: In this study, 167 dentists working in Turkey were included, and they were asked to respond to a questionnaire consisting of 17 questions covering gender, the institution they work at, specialty, the years they have been practicing, and information related to the stages of root canal treatment. The data obtained from this study were analyzed using the Chi-square test, Fisher's Exact test, and Pearson Chi-square test, based on the number of observations in the tables. Results: Of the participants in the study, 53.89% reported attending any seminar/course related to endodontics after graduation. Additionally, 43.71% of the participants perform more than 30 root canal treatments per month. Notably, 91.02% of the participants typically perform root canal treatments on molar teeth. However, 77.25% of the participants do not use rubber dams during treatment, and 91.02% do not utilize magnification during root canal procedures. There is a statistically significant relationship between titles and the frequency of performing root canal treatments (p<0.05). Among the endodontists, 85.71% perform more than 30 root canal treatments per month, while 37.67% of general dental practitioners do the same; conversely, 18.49% of general dentists perform between 0-10 root canal treatments per month. Furthermore, there is a statistically significant relationship between titles and the use of rubber dams during root canal treatments (p<0.05). While 38.1% of endodontists and 82.88% of general dental practitioners do not use rubber dams during treatment, 14.29% of endodontists and 2.05% of general dentists always use rubber dams. Lastly, there is also a statistically significant relationship between titles and the utilization of magnification during treatment (p<0.05). While 76.19% of endodontists and 93.15% of general dental practitioners do not utilize magnification during treatment, 0.68% of general dentists occasionally use loupes or smartphone cameras for assistance. Conclusion: The results of this study indicate that general dental practitioners lack sufficient knowledge regarding current irrigation and obturation protocols and materials. Additionally, it was observed that endodontists possess relatively more knowledge on this subject compared to general dental practitioners. While the efforts of practitioners to improve their perspectives on root canal treatment through education and course participation is a positive outcome, it also raises concerns about the adequacy of undergraduate education in this field.

Older adults with serious illness are particularly vulnerable to oral disease due to worsened overall health, progressive functional loss and polypharmacy. Meanwhile, inability to communicate oral health needs, increased functional disability and psychological distress also hamper timely oral health care and lead to prolonged suffering and compromised quality of life. While many seriously-ill older adults with poor oral health receive no oral health care prior to death, unnecessary treatment is also common. In response to these issues, a new oral health care model is proposed to better address the oral health needs of older adults with serious illness. This model aims to promote comfort, maintain oral function and improve quality of life. End-of-life oral health trajectories and stage-appropriate oral health care strategies are also introduced to guide the care of these vulnerable individuals.

Root canal treatment in several regions of Saudi Arabia is commonly administered by general dental practitioners (GDPs) rather than specialized endodontists. The study aimed to compare the endodontic practices and preferences of general dental practitioners with those of endodontists and restorative specialists. A structured questionnaire including 23 questions focussing on fundamental principles and techniques used in contemporary root canal treatment was distributed online to 600 dentists who perform root canal treatments and are registered with the Saudi Dental Society (SDS). Data were gathered for basic demographic and professional details, practices, and preferences in endodontic materials and methods. The collected data were analyzed using SPSS version 21 (Armonk, NY: IBM Corp.). For selected variables, frequency distributions and 95% confidence interval for sample proportions were measured. Associations between categorical variables were examined using cross-tabulation, with statistical significance assessed by the chi-square test of homogeneity or Fisher's exact test when necessary. The survey, with a 59% response rate primarily from participants aged 24-34 years (94.1%) with one to five years of experience (90.4%), revealed that most GDPs referred root canal treatment (RCT)cases due to lack of skills (82.8%), performed restorability assessments (90.9%), preferred Cavit for tooth buildup (87%), consistently used rubber dam isolation (91.5%), treated mainly anterior teeth (91.2%) without magnification (87.9%), used electronic apex locators for working length determination (63.3%), favored stainless steel K files and single cone obturation, while specialists exhibited wider clinical experience, more frequent use of advanced techniques, and higher usage of intracanal medicaments (91.7%) and ethylenediaminetetraacetic acid (EDTA) as irrigant (70.8%). The study provides valuable insights into the endodontic preferences and practices of dentists in the Kingdom of Saudi Arabia, revealing significant differences between general dental practitioners and specialists. The findings highlight critical areas for improvement, such as the need for enhanced training in endodontic skills and better access to modern materials and equipment.

Background: Oral health is also considered as an integral part of the overall health of individuals where it acts as a mirror of the body and general health. Medical professionals have an early opportunity to diagnose the signs of oral disorders and can help dental professionals for timely intervention. Materials and Methodology: After taking an informed consent, a standard questionnaire was asked to be filled by a total of three hundred and twenty seven participants (Doctors, Medical and Nursing students). Analyses were done with regard to knowledge, practice and awareness of oral dental health of the participants. The data was analyzed using chi-square test for categorical data. Results: Regarding the knowledge of oral health, 92% of the participants were aware that brushing prevents tooth decay and periodontal diseases. Regarding the attitude towards oral health, 81% of the participants were aware that dental check-up is necessary during pregnancy. Regarding awareness about oral health, 83% knew that oral and general health were related. Regarding root canal treatment, only 57-73% participants correctly responded to the given questionnaire. However, a statistically significant difference was observed between medical and nursing professionals regarding knowledge pertaining to oral health and root canal treatment. The oral health knowledge, attitude and awareness was limited to very few areas like importance of brushing, the importance of maintaining oral health during pregnancy and relation of oral and general health. However, knowledge about preserving the grossly decayed tooth by root canal treatment and its success was very limited in medical professionals. Conclusion: Medical professionals have better knowledge, awareness and attitude about oral health than nursing students and faculty.

To evaluate the views of final year dental surgery students (BDS; G1) at Cardiff University and general dental practitioners (GDPs; G2) within the geographic area of Cardiff, Wales, on antibiotic prescribing for endodontic conditions, and investigate the potential differences between the two groups. A cross-sectional online questionnaire-based survey of 12 qualitative and quantitative questions was distributed to 76 final year BDS Cardiff University students and 55 dental practices within Cardiff, UK. Six questions recorded general information, and the remaining questions included a series of hypothetical clinical scenarios, where the participants were asked to state whether they would or would not prescribe antibiotics. The data were analysed using spss version 23 to produce descriptive statistics, contingency tables and to run chi-square (χ²) tests, Fisher's exact tests and relative risk calculations. The response rate was 60% (n=79). All G1 participants were aware of the consequences of antibiotic overuse. Approximately 60% of responders were aware of guidelines for antibiotic use in endodontic therapies, and 83% would only use antibiotics for a limited selection of patients (e.g. patients with systemic complications). G1 responses to clinical scenarios indicated overall that they were comparable to the ideal answers except for acute apical abscess (64% believed that antibiotics were indicated). The majority of G2 were aware of the consequences of antibiotic overuse. Only 28% of G2 were aware of guidelines for antibiotic use in endodontic therapies. Overall responses revealed that antibiotics would be prescribed for: systemic complications (78%), acute apical abscess (72%) and symptomatic apical periodontitis (28%). The clinical scenarios revealed G1 were more likely to prescribe antibiotics compared to G2 for cases of necrotic pulp with symptomatic apical periodontitis without systemic complications (incorrect answer) and less likely to other clinical scenarios such as necrotic pulp and asymptomatic apical periodontitis for patients with a history of rheumatic fever (ideal answers), symptomatic irreversible/reversible pulpitis, failure to achieve anaesthesia, chronic apical abscess for patients with diabetes. The recognition of antibiotic prescription for cases with signs of spreading infection was more evident in G2. Final year undergraduate students were aware of the antibiotic resistance crisis, although a third was not aware of guidelines for use of antibiotics in endodontic conditions; their responses to clinical scenario were generally compatible with the guidelines. General dentists were less aware of the implications of overuse of antibiotics and the existence of guidelines, and their responses were occasionally incompatible with antibiotic guidelines for endodontic therapies.

To identify current trends of root canal treatment for patients with special needs. A postal questionnaire was sent to General Dentists in Victoria, Australia and Endodontists and Special Needs Dentists across Australia to determine the extent of root canal treatment performed on special needs patients. Over a four-month period, 1120 questionnaires were distributed with an overall response rate of 63.9% (n=716). Response rates were 63.2% (n= 655), 68.5% (n=50) and 100.0% (n=11) amongst General Dentists, Endodontists and Special Needs Dentists, respectively. Endodontists (95.7%) and Special Needs Dentists (100.0%) performed significantly more root canal treatment on adult patients with special needs compared with 51.2% of General Dentists, (P<0.001 and P=0.001 respectively; Fisher's exact test). The most common reasons for not undertaking root canal treatment included limited cooperation, poor oral hygiene and uncontrolled movement. Amongst General Dentists, 75.7% opted for extraction in preference to root canal treatment. Significantly, more specialist practitioners performed root canal treatment utilizing conscious sedation (P<0.001) and general anaesthesia (P=0.003). Most specialist practitioners (69.1%) had undertaken single-visit root canal treatment on special needs patients compared with only 29.7% of General Dentists (P<0.001). Root canal treatment in special needs patients was more likely to be carried out by specialist dental practitioners who were more likely to utilize a pharmacological approach for behaviour guidance and to perform single-visit root canal treatment compared with General Dentists. A multidisciplinary approach for special needs patients who require root canal treatment provides an opportunity for these patients to retain their dentition.

Introduction: Studies in many countries have reported that dentists do not always comply with treatment quality guidelines when undertaking root canal treatment (RCT). However, there is no information on the compliance of dentists in Qatar with quality guidelines. Using an online questionnaire, this study aimed to collect baseline information on how dentists working within the Primary HealthCare Corporation (PHCC), Qatar, carried out RCT. Materials and Methods: A questionnaire was E-mailed to general dental practitioners (GDPs) and specialists. The questionnaire collected demographic information, continuous professional development (CPD) hours, information on early stages of RCT, RCT protocols, use of technology and materials. Statistical analyses were undertaken using version 27 SPSS software. Results: The response rate was 55% of GDPs and 83% of specialists. Twenty-six percent of GDPs never used rubber dams whereas specialists always used rubber dam (P &lt; 0.001). The 57% of GDPs who undertook a complete RCT reported they treated mostly anterior and premolar teeth with few molars (12%), few attempted RCT retreatment (4%). All specialists treated molars (P &lt; 0.001) and 50% undertook retreatment (P &lt; 0.001). The majority of specialists reported using magnification (55%) with only 23% of GDPs using loupes (P &lt; 0.001). During the past 2 years, 42% of specialists earned &gt; 20 CPD hours which was significantly more than the 50% of the GDPs who undertook &lt; 5 h (P &lt; 0.001). Conclusions: Half of the GDPs working within the PHCC do not carry out RCT nor rubber dam isolation due to short duration of treatment session. Specialists generally follow the current guidelines when providing RCT, while the GDPs do so less often.

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

Objective: To reduce the gap between what can be achieved in endodontic treatments and the observed treatment outcome among general dental practitioners, the present study set out to assess the status of the endodontic practices as regards to knowledge and self-assessed skills among general dental practitioners in Sweden and Norway.Material and method: The questionnaire was sent to 1384 general dental practitioners. It contained questions regarding access to continuing education in endodontics, sources of knowledge for clinical management of patients, post-operative follow-ups, self-assessed success-rate, and the initial diagnosis impact on the outcome of endodontic treatments.Results: The response rate was 61.4%. Almost half estimated their endodontic success-rate to be 90%. About two-thirds of the respondents did not know, or did not believe, that the initial diagnosis could affect the outcome of their endodontic treatments. Respondents who did not believe the diagnosis could impact the outcome were more likely to estimate their success rate as the highest (p<.001). Less than half performed post-operative follow-ups a year after treatment. A third of the respondents had not attended any continuing endodontic education.Conclusion: Dentists who do not receive regular feedback on their treatments may lack insight into their own shortcomings. If this is combined with insufficient knowledge and understanding it may result in sub-par endodontic treatments being performed. It is important to have reliable ways to communicate current endodontic knowledge and to establish robust methods that may help dentists accurately assess their own performance in endodontics.

Background:Endodontic emergencies are one of the most common emergencies that dentists face during their career. Objectives: This study aimed to evaluate and assess the difference between general dentists and endodontists in managing endodontic emergency cases. Also, it highlights the risk of bacterial resistance due to an inappropriate antibiotic prescription. Methods: A cross-sectional study conducted at King Abdul-Aziz University Dental Hospital, a self-administered survey was distributed to 521 dental patients. The response rate was 82.9% (432 out of 521). The survey, available in both paper and electronic formats, comprised 24 questions organized into three main sections: the first section collected demographic and medical history data, the second focused on the patients' dental history related to emergencies, and the third detailed the treatment received during emergencies and the methods employed. A Fisher's exact test was utilized to assess significant differences between general dental practitioners and endodontic specialists regarding their initial steps, reasons for treatment, swelling conditions, biting and chewing conditions, and final treatments. Data analysis involved simple descriptive statistics, including percentages, frequency distributions, pie charts, and bar graphs. Statistical significance was determined with a p-value set at ≤ 0.05. Results: The study revealed that decay was the most prevalent reason for endodontic treatment, with immediate treatment being the preferred choice among dentists. Despite the well-documented issue of endodontic treatment failure due to inadequate coronal sealing, the majority of general dentists performed root canal treatments followed by either temporary or permanent restorations. Additionally, the study found that general dentists prescribed antibiotics more frequently than endodontists. Conclusion: The study findings indicate the need to develop intervention programs targeting clinicians to enhance knowledge about prescribing antibiotics for endodontic emergencies.

Introduction Considering an ageing population with increasing comorbidities, access to oral and general healthcare is a growing concern. This study aimed to identify and compare access to dental and general practices. This study further aimed to ascertain if there exists a socioeconomic distribution of dental and general practices among older adults.Materials and methods A total of 13,007 dental practices and 13,759 general practices were mapped using geographic information system software, and overlaid with the UK older adult population and deprivation data by health areas. Data analysis was carried out by creating a geographical distribution map and by using descriptive statistics, Gini coefficients and Lorenz curves.Results NHS Central London Clinical Commissioning Group (CCG) held the highest dental practice-to-population ratio of 958 practices per 100,000 older adults, while NHS Manchester CCG held the highest general practice-to-population ratio of 264.4 general practices per 100,000 older adults. England had the highest Gini coefficients for general and dental practice at 0.214 and 0.195, respectively. Both dental and general practices were socioeconomically distributed among older adults in England, Wales and Northern Ireland, but not in Scotland.Conclusions An increasing proportion of older adults need access to healthcare that is based on clinical need, not the ability to pay; a founding principle of the NHS. This nation-wide study captures inequities in the spatial accessibility for older adults in the UK.

This paper undertakes a broad and comprehensive synthesis of relevant clinical, biological, biomechanical, technical and healthcare services data to understand the factors affecting outcomes of periapical healing after root canal (re)treatment. The medical and dental evidence-based era (1980-present) is contextualized with the earlier evidence drive in endodontics (1911-1940) triggered by the focal infection era. The current evidence-based approach has a sharper focus on evidence quality and derivation of practice guidelines. Contrary views question whether guideline-driven, or expertise-development-driven endeavours would best serve outcome improvement in society. The endodontic discipline functions in a broad healthcare framework and sustains industrial, economic and trend pressures that may be deemed to influence outcomes. The nature of root canal treatment and the challenges in determining the factors that affect its outcomes is discussed. The factors potentially affecting periapical healing after root canal treatment are classified into pre-operative, intra-operative and postoperative groups. These categories subsume multiple elements with interactive influences, creating a complex picture, further confounded by some apparently surprising, counter-intuitive and contradictory findings. The technical versus biological conundrum in root canal treatment continues to cause cognitive dissonance. However, due reflection and cross-discipline-synthesis resolve the apparent data conflicts into a very simple, consistent and plausible picture of how root canal treatment works and the key factors that affect periapical healing. Root canal retreatment is considered mainly in the context of its differences from primary treatment as the majority of factors influencing outcomes are common to both. The exceptional difference is that retreatments have a proportionately reduced probability of healing by virtue of compromised apical root canal ramification access or modified host/infection interactions. Root canal (re)treatment outcomes are dominantly influenced by the nature of prior dynamic host/infection interaction (pre-operative patient factors) and how the direction of this dynamic is influenced by two factors: (1) the active efficacy of the operators' root canal treatment protocol to sustain a microbial ecological shift (intra-operative treatment factors) anddampenperiapicalinflammation; and (2) the passive ability of the functional tooth (and its restoration margin) to maintain its integrity to resist infection reversal (postoperative restorative factors).

Diseases of the dental pulp and periapical tissues are chiefly caused by microorganisms. Antibiotics are used in some endodontic cases; however, successful cases can predominantly be achieved by mechanical and chemical cleaning of the canal or surgical intervention. The aim of this study was to determine the knowledge of General Dental Practitioners (GDPs) in Shiraz in respect to antibiotic prescriptions during and after endodontic treatment. A one-page questionnaire was sent to 200 active general dentists. Of the 120 surveys returned, 93 were accepted. The data were analyzed using t-test, Chi-square, ANOVA and Fisher's Exact Test. Only 29% of dentists had full knowledge (correct answers to all questions) of antibiotic prescription protocols in pulpal and periapical disease. Amoxicillin 500 mg capsule was the drug of choice of dentists. Total of 42% of GDPs had full knowledge of antibiotic prescription protocols for persistent or systemic infections cases. GDPs more recently qualified had slightly greater knowledge compared to GDPs with experience; however, this difference was not significant. Also, there was no significant difference between genders. General practitioners' knowledge about antibiotics seems inadequate and further education is recommended to update the practitioners.

Objectives: The aim of this article is to evaluate attitude among dental practitioners in Erbil/Iraq toward the use of hand and rotary endodontic instruments and to evaluate whether there is any relation regarding the preference in using a specific type of instrument with the level of specialization and clinical practice when performing root canal treatments (RCTs). Materials and Methods: It was a cross-sectional questionnaire study conducted in Erbil, Iraq. A total of 111 dentists participated in this study; data regarding the information about demographic details of dental professionals, years of experience, and number of RCTs done per week by dental professionals were obtained. The use of rotary and hand instruments by dental professionals was inquired. Procedural problems with rotary instruments faced by dental professionals and reasons for not using the rotary instruments if any were also recorded. The data were submitted to descriptive analysis, and associations were tested with χ2 test and Fisher's exact test using SPSS software version 23. P-value was set as &lt;0.05. Results: Forty-four (39.6%) of the total study samples used both rotary and hand instruments, whereas 25 (22.5%) of them used only rotary instruments for RCTs. Dentists who were using rotary instruments are facing the procedural problems of file fracture [74 (66.7%)] and those dental professionals using hand instruments are facing the procedural problems of ledge formations [55 (49.5%)]. There was no significant relationship between using a specific type of instrument and the level of specializations (P = 0.941). Conclusion: In conclusion, the results of this study showed that dentists preferred using both rotary and hand endodontic instruments for RCTs with no significant relation with the level of specialization regarding using specific types of instruments, and dentists experienced some procedure errors regarding both types of instruments while using them for RCTs.

Objective: The purpose of this study was to investigate endodontic infection prevention and control routines among general dental practitioners in Sweden and Norway.Materials and methods: A questionnaire was sent by email to 1384 general dental practitioners employed in Sweden and Norway. The participants were asked questions concerning different aspects of infection prevention and control during endodontic treatment; use of rubber dam, sealing of rubber dam, antibacterial solutions, and use of hand disinfectant and gloves.Results: The response rate was 61.4% (n: 819). 96.9% reported routinely using rubber dam during endodontic treatment. 88.3% reported always, or sometimes, sealing the area between rubber dam and tooth. Most disinfected the endodontic operative field, but the antibacterial solutions used varied. 11.9% did not use gloves at all during treatment, and 10.5% did not use hand disinfectant during treatment.Conclusions: Most of the general dental practitioners took measures to establish and maintain aseptics during endodontic treatment, which infers an awareness of the importance of endodontic infection prevention and control. But the results were self-reported and there may be a gap between claimed and actual behaviour. Further studies using observation methodologies are needed to assess how infection control routines are performed in everyday clinical practice.