Patients report that root canal work not so bad after all — Australian study

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An Australian dental health study suggests that patients find the root canal procedure no worse than other dental work, overturnING the popular belief that it is the most unpleasant and painful dental treatment.

Dr Tallan Chew, postgraduate student, Adelaide Dental School, University of Adelaide co-authored the study. "Information about 1,096 randomly selected Australian people aged 30-61 was collected through questionnaires, dental records and treatment receipts in 2009. Their self-rated dental health score was checked when they had their dental work and two years later," she says.

"Patients who had root canal work reported similar oral health-related quality of life as people who had other types of dental work. The effect of root canal work on patients' oral health-related quality of life was compared to other kinds of dental work such as tooth extraction, restoration of teeth, repairs to the teeth or gum treatment, preventative treatment and cleaning."

Every year millions of root canal treatments are performed globally (more than 22m in the US alone), which may have a profound positive effect on the quality of life of patients. A root canal treatment repairs and saves a tooth that is badly decayed or is infected. During a root canal procedure, the nerve and pulp are removed and the inside of the tooth is cleaned and sealed. Most people associate having root canal work with a lot of pain and discomfort.

"There is growing interest in the dental profession to better understand the effect and impact oral diseases and their associated treatment, such as root canal work, have on patients' quality of life," says Professor Giampiero Rossi-Fedele, head of endodontics at Adelaide Dental School, University of Adelaide who co-authored the study.

"A biopsychosocial view of health is increasingly replacing a purely biomedical model.

"Treatment outcomes need to be re-examined from a patient-based perspective using self-reported measures as this more accurately reflects the patients' perception of treatment outcomes and the effect it has on their overall well-being.

"Patient-reported treatment outcomes are now the principle driving force behind treatment needs, as opposed to clinician-based treatment outcomes.

"With this change in emphasis, the perspectives of patients and their relatives are important factors in identifying need for treatment, treatment planning, and determining outcomes from any health care intervention as part of shared decision making," says Rossi-Fedele.

Introduction: The literature assessing quality of life for subjects who have undergone root canal treatment (RCT) is scarce. The aim of this study was to compare the effect of RCT with other dental services (exodontia, restorative, prosthodontics, periodontics, and negative controls [preventative and scale and clean]) on oral health–related quality of life.
Methods: A random sample of 3000 adults aged 30–61 years was obtained from the Australian electoral roll in 2009. Data were collected through questionnaires, dental service logbooks, and treatment receipts. The impact their dentition had at baseline and the 2-year follow-up for the Oral Health Impact Profile-14 and the self-rated dental health score followed by “global transition statement of change” (GTSC) was assessed. Binary regression models were used to compare the outcomes.
Results: Responses were collected from 1096 respondents (response rate = 36.5%). After adjustment (for age, sex, household income, and reason for visit), the RCT group had significant differences (P ≤ .05) to other dental services at the 2-year follow-up using the Oral Health Impact Profile-14 (odds ratio = 0.34; 95% confidence interval, 0.12–0.96) and GTSC (odds ratio = 0.29; 95% confidence interval, 0.09–0.88) but not with individual treatment groups. Using the self-rated dental health score/GTSC, only the prosthodontic treatment group had a significant difference to the RCT group at baseline, whereas the negative controls (P ≤ .01) had significant differences to the RCT group with the odds for improved health 5 times higher, at 2-year follow-up.
Conclusions: The RCT group presented with similar oral health–related quality of life when compared with the other individual treatment groups; however, they consistently reported poorer oral health outcomes when the negative controls were included.

Tallan Chew, David Brennan, Giampiero Rossi-Fedele

University of Adelaide material Journal of Endodontics abstract

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