View - CTU

OOOOE
Volume 103, Number 4
Bj¢mdal et al. 575
they are good at doing it, but often perform inadequately.
In the terms of Hays et al., 10 it might be
suggested that these are signs of lack of insight, with
insight defined as "an awareness of one's performance
in the spectrum of medical practice." According to
Hays et al., 10 insight may be regarded as a combination
of 3 related constructs: awareness of one's own performance,
awareness of the performance of others, and a
capacity to reflect on both of these measures. A complementary
interpretation of data is that, since the focus
of the Danish GDPs seems to be on the presence or not
of clinical symptoms, even root-filling quality of low
technical quality is accepted as long as it prevents such
symptoms.
Within the GDP group, large interindividual variations
were found. Sex, year of education, and exposition
to endodontic treatment could explain parts of this
variation. The women regarded factors like periapical
status, fever, swelling, and fistula to have greater impact
on treatment outcome than did the male respondents.
Young practitioners gave higher scores to microbiologically
related operative factors such as "presence
of bacteria in the root canal after completion of the
instrumentation" and "interappointment dressing in relation
to the treatment of the infected pulp." As could
be expected, the GDPs with a higher weekly exposure
to endodontic treatment did not assess tooth type as so
important to the outcome as those treating root canals
on a more irregular basis.
When levels of episteme and techne were self-assessed
by the practitioners, the grade "nonsatisfactory"
was rarely used (Table I). However, 40.8% regarded
their knowledge of microbiology not to be up to standard.
Again, this supports the notion that Danish GDPs
look on endodontics as not so much a measure of
preventing or treating an infectious condition like pe1iapical
disease, but as a procedure to keep a patient
symptom-free. As long as the treatment fulfills that
goal, it seems widely accepted, even if the root filling is
of low technical quality.
The general dental practitioners are gratefully acknowledged
for their contribution to the present study. Professor Niels
Keiding, Department of Biostatistics, University of Copenhagen
is kindly acknowledged for his statistical support.
Line Conradsen and Lisbeth Carstensen are acknowledged
for running the analyses.
REFERENCES
I. Bj¢mdal L, Reit C. The annual frequency of root fillings, tooth
extractions and pulp related procedures in Danish adults during
1977-2003. Int Endod J 2004;37:782-8.
2. Petersson K, Petersson A, Olsson B, Hi\kansson J, Wennberg A.
Technical quality of root fillings in an adult Swedish population.
Endod Dent Traumatol 1986;2:99-102.
3. Eriksen HM, Bjertness E, 0rstavik D. Prevalence and quality of
endodontic treatment in an urban adult population in Norway.
Endod Dent Traumatol 1988;4: 122-6.
4. Saunders WP, Saunders EM, Sadiq J, Cruickshank E. Technical
standard of root canal treatment in an adult Scottish sub-population.
Br Dent J 1997;182:382-6.
5. Kirkevang L-L, 0rstavik D, Horsted-Bindslev P, Wenzel A.
Periapical status and quality of root fillings and coronal restorations
in a Danish population. Int Endod J 2000;33:509-15.
6. Dugas NN, Lawrence HP, Teplitsky PE, Pharoah MJ, Friedman
S. Periapical health and treatment quality assessment of rootfilled
teeth in two Canadian populations. Int Endod J
2003;36:181-92.
7. McColl E, Smith M, Whitworth J, Seccombe G, Steele J. Barriers
to improving endodontic care: the views of NHS practitioners. Br
Dent J 1999;186:564-8.
8. Molander A, Caplan D, Bergenholtz G, Reit C. Improved
root-filling quality among general dental practitioners educated
in nickel titanium rotary instrumentation. Int Endod J (in
press).
9. Bj¢mdal L, Reit C. The adoption of new endodontic technology
amongst Danish general dental practitioners. Int Endod J
2005;38:52-8.
10. Hays RB, Jolly BC, Caldon LJ, McCrorie P, McAvoy PA,
McManus IC, et al. Is insight important? Measuring capacity to
change performance. Med Educ 2002;36:965-71.
11. Reit C, Bergenholtz G, H¢rsted-Bindslev P. Introduction to endodontology.
In: Bergenholtz G, H¢rsted-Bindslev P, Reit C,
editors. Textbook of endodontology. Oxford: Blackwell Munksgaard;
2003. p. 3-8.
12. Aristotle. In: !ruin T, editor. Nicomachean ethics. London:
Hackett Publishing; 1988.
13. Bj¢mdal L, Laustsen MH, Reit C. Root canal treatment in
Denmark is most often carried out in carious vital molar teeth
and retreatments are rare. Int Endod J 2006;39:785-90.
14. Reit C, Grondahl H-G. Endodontic decision-making under uncertalnty:
a decision analytic approach to management of periapical
lesions in eadodontically treated teeth. Endod Dent Traumatol
1987;3:15-20.
15. Kreiner S. Introduction to DIGRAM. Copenhagen (Denmark):
University of Copenhagen, Department of Biostatistics. [cited
2006 Jan 10th]. Available from: http://biostat.ku.dk/-slan/
skm/index.html.
16. Upton G. Goodman-Kruskal measure of association. In: Armitage
P, Colton T, editors. Enclyclopedia of statistics. Vol. 2.
Weinheim: WILEY-VHC; 1999. p. 172.
17. Parashos P, Messer HH. Questionnaire survey on the use of
rotary nickel-titanium endodoatic instruments by Australian dentists.
Int Endod J 2004;37:249-59.
18. Reit C, Heden G, Milthon R. Endodoatiskt behandlingspanorama
inom allmantandvilrden. Tandliikartidningen 1993;85:543-6.
19. Karlsson P-0, Reit C. Reasons for endodoatic treatment among
Swedish general practitioners [abstract]. Int Endod J 1994;27:100.
Reprint requests:
Lars Bj¢mdal, DDS, PhD
Department of Cariology and Endodontics
Faculty of Health Sciences
N¢rre Alie 20
DK-2200 Copenhagen N
Denmark
lb@odont.ku.dk
Bj0rndal L
Internation
Reprinted wi