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Bj¢rndal et al. Reasons for root canal treatment he root canal treatment ,1 n 1lucency 1%) 0 311) 00 611) 61 114) 0 112 125) 104123) 99 122) 44110) 16 14) 0 411) 1 3 11) 5 11) 452 nee scores as assessed by scales, are presented in eatment of a mandibular points of the 100-mm ed as 'very easy' and espectively y-coefficient IP-value) y = 0.31 IP= 0.014) y = 0.29 IP< 0.0005) y = 0.20 IP= 0.010) 105 mina 12) >105 min 1%) 37 18) ed questionnaire was ~uarantee letter incluenvelope. Nonrespona reminder card and : Burke 1997). The use of coded reply envelopes led to failed responses by at least 1.7% of the GDPs. The final response rate (75.3%) was regarded as sufficient to make valid conclusions (Parashos & Messer 2004). The results of the present study provide some evidence that caries is still the main cause of pulp disease and thus endodontic treatment in the Danish population. This situation is valid for all age groups except the youngest one, in which traumatic injury was a major reason for root canal treatment (Table 3). In older patients with a high frequency of restored teeth, cusp fractures and dentinal cracks might be expected to challenge caries as the major reason of pulp injury, but these possibilities were not reported frequently. Reasons for caries still being the main cause for root canal treatment could be that the teeth that were previously extracted due to caries amongst Danish children (Poulsen & Malling Pedersen 2002) might now be candidates for root canal treatments. Seventy-nine per cent of root fillings were attributed to caries and pulp disease in the 20-29-year age group in the present study (Table 3). It could be speculated that the first operative interventions in these deep carious lesions have been postponed over the years, and perhaps take place in an increasing group of socalled 'drop-out' patients, who do not attend the dental service on a regular basis (Petersen et al. 2003). In addition, the long-time consequences of the overall reduced caries progression (Marthaler 2004) mean that now it takes longer time for a cavity to progress to a deep stage. The level of clinical symptoms such as pain might also be reduced as the progression is slow. Taken together, the caries lesion may also become a potential candidate for root canal treatment, even without the patient has taken notice of the problem. However, the increased focus on the procedures of caries management, involving an understanding of pulp-dentinal changes in relation to rapidly and slowly progressing deep carious lesions (Bj0rndal & Kidd 2005), may in the future lead to treatment of deep caries lesions that preserve pulp health (Bj0rndal & Reil 2005a,b). In accordance with earlier studies (Reit et al. 1993, Karlsson & Reit 1994), root canal treatment was reported to be undertaken in teeth with clinical symptoms (Table 2). Pulpitis was the dominating condition, particularly amongst patients between 20 and 40 years of age (Table 3). Epidemiological surveys have observed apical periodontitis to be associated frequently in root filled teeth (Eriksen et al. 2002). Also, reports from Denmark and other countries have pointed out high frequencies of sub-standard root fillings (Kirkevang et al. 2001, Dugas et al. 2003). In spite of these facts, retreatments were rarely reported (2%) by the GDPs in the present study. It is obvious that the mere diagr;osis of a periapical lesion in a symptom-free root filled tooth (even if the root filling is inadequate) will not motivate a retreatment decision (Kvist et al. 2004). The present study confirms recent reports stating that root canal treatment is now the most common in molar teeth (Kirkevang et al. 2001). Sixty per cent of the GDPs completed their latest root filling in a molar tooth. It is obvious that, over the years, the spectrum of root canal treatment has changed. Molars are now extracted less often and are preserved with root canal treatment if indicated (Bj0rndal & Reit 2004). Thus, contemporary endodontic treatment will often involve technically demanding cases. Therefore, the GDPs were asked to assess the difficulty of various technical aspects of a molar treatment. Considering the high frequency of inadequate root fillings, the scores were found to be surprisingly low. All mean values were situated in the 'easy' half of the scale (Table 4). The preparation of an aseptic working field was given the highest mean VASvalue, and approached 44 when compared with 40 for root canal preparation (no statistical difference). In Denmark. as in other countries, rubber dam is rarely used by GDPs as a part of an aseptic working field (Saunders et al. 1999a, Jenkins et al. 2001, Slaus & Bottenberg 2002, Bj0fndal & Reit 2005c). To produce asepsis without the use of rubber dam is difficult; and as a majority of the treated cases have vital pulps, the risk of microbial contamination is high, which, in turn, might be an explanatory factor for the high rate of periapical lesions observed in root filled teeth. Fifty-six per cent of the responders estimated the time to treat a mandibular molar at between 46 and 75 min. Mechanical root canal preparation was reported as being the most time-consuming procedure. Compared with other self-reported time evaluations, this is relatively rapid. In a Scottish sample (Saunders et al. 1999b), the treatment of a single-rooted tooth was estimated to take about 70 min. It has been suggested that the attitude of working rapidly within endodontics is associated with a low economic incentive (Basmadjian-Charles et al. 2004). The timecost dilemma was also elaborated by McColl et al. (1999). Gender influenced the reported time spent on root canal treatment. Female GDPs reported using significantly more time to prepare an access cavity and the root canals as well as filling the canals. The impact of gender was also found in another Danish sample, in which female GDPs completed teeth with vital and ternational Endodontic Journal © 2006 International Endodontic Journal International Endodontic Journal, 39, 785-790, 2006
Reasons for root canal treatment Bj¢rndal et al. nonvital pulps in significantly more visits than males (Bjmndal & Reit 2005c). Conclusions The present study has found that root canal treatment in Denmark was still most often associated with caries and pulpitis. Treatment was typically instituted in vital molar teeth. Even though apical periodontitis is frequent in root filled teeth, retreatments were rare. From a subjective point of view, root canal treatment was not evaluated as 'very difficult' and was carried out rapidly. Aclmowledgements The GDPs are gratefully acknowledged for their contribution to the present study. Professor Niels Keiding, Department of Biostatistics, University of Copenhagen is kindly acknowledged for his critical review of the paper. Line Conradsen and Lisbeth Carstensen are aclmowledged for running the statistical analyses, This research was financially supported by Danish Regions. References Basmadjian-Charles C, Bourgeois D, Coudeville L, Lebrun T (2004) National survey of endodontics in general dental practice in France. Tlie European Journal of Prostlwdontics and Restorative Dentistry 12, 144-53. Bjorndal L, Kidd EAM (2005) The treatment of deep dentine caries lesions. Dental Update 32, 402-13. Bjorndal L, Reit C (2004) The annual frequency of root fillings, tooth extractions and pulp-related procedures in Danish adults during 1977-2003. International Endodontic Journal 37, 782-8. Bjorndal L, Reit C (2005a) The CAP-1 trial: stepwise excavation versus one completed excavation in deep caries [WWW document]. URL http:/ I clinicaltrials.gov I ct/ show /NCTOO 18 7 8 3 71 order=l [accessed on 7 November 2005]. Bjorndal L, Reit C (2005b) The CAP-2 triaL· effect of direct pulp capping versus partial pulpotomi [WWW document]. URL http://clinicaltrials.gov/ ct/show/NCTOOl 8 78 5 O?order=8 [accessed on 7 November 2005]. Bjorndal L, Reit C (2005c) The adoption of new endodontic technology amongst Danish general dental practitioners. International Endodontics Journal 38, 52-8. Dugas NN, Lawrence HP, Teplitsky PE, Pharoah MJ, Friedman S (2003) Periapical health and treatment quality assessment of root-filled teeth in two Canadian populations. International Endodontic Journal 36, 181-92. Eriksen HM, Kirkevang L-L, Petersson K (2002) Endodontic epidemiology and treatment outcome: general considerations. Endodontic Topics 2, 1-9. Jenkins SM, Hayes SJ, Dummer PMH (2001) A study of endodontic treatment carried out in dental practice within the UK. International Endodontic Journal 34, 16-22. Karlsson P-0, Reit C (1994) Reasons for endodontic treatment among Swedish general practitioners. (ESE abstract). Intanational Endodontic Journal 27, 100. Kirkevang L-L, Hilrsted-Bindslev P, 0rstavik D, Wenzel A (2001) A comparison of the quality of root canal treatment in two Danish subpopulations examined 1974-75 and 1997-98. International Endodontic Journal 34, 607-12. Kreiner S (2003) Introduction to DIGRAM. University of Copenhagen: depm·tment of biostatistics [WWW document]. URL http://www.biostat.ku.dk/ ~skm/skm/index.html. Kvist T, Heden G, Reit C (2004) Endodontic retreatment strategies used by general dental practitioners. Oral Surgery Oral Medicine Oral Pathology Oral Radiology Endodontics 97, 502-7. Marthaler TM (2004) Changes in Dental caries 1953-2003. Caries Researc/1 38, 173-81. McColl E, Smith M, Whitworth J, Seccombe G, Steele J (1999) Barriers to improving endodontic care: the views of NHS practitioners. British Dental Journal 186, 564-8. Parashos P, Messer HH (2004) Questionnaire survey on the use of rotary nickel-titanium instruments by Australian dentists. International Endodontic Journal 37, 249-59. Petersen PE, Kjoller M, Christensen LB, Krustrup U (2003) Voksenbefolkningens tandstatus og udnyttelse af tandplejetilbuddet i Danmark 2000. Tandlaegebladet 107, 6 72-84. Poulsen S, Malling Pedersen M (2002) Dental caries in Danish children: 1988-2001. European Journal of Peadiatric Dentistry 4, 195-8. Reit C, Heden G, Milthon R (1993) Endodontiskt behandlingspanorama inom allmiintandvarden. Tandliikartidningen 85, 543-6. Saunders WP, Chestnutt IG, Saunders EM (1999a) Factors influencing the diagnosis and management of teeth with pulpal and periradicular disease by general dental practitioners. Part 1. British Dental Journal 187, 492-7. Saunders WP, Chestnutt !G, Saunders EM (1999b) Factors influencing the diagnosis and management of teeth with pulpal and periradicular disease by general dental practitioners. Part 2. British Dental Journal 187, 548-54. Slaus G, Bottenberg P (2002) A survey of endodontic practice amongst Flemish dentists. International Endodontic Journal 35, 759-67. Tan RT, Burke FJT (199 7) Response rates to questionnaires mailed to dentists. A review of 77 publications. International Dental Journal 47, 349-54. Upton G (1999) Goodman-Kruskal measures of association. In: Armitage P, Colton T, eds. Encyclopedia of Biostatistics, Vol. 2. Weinheim, Germany: WILEY-VCR, pp. 172. Bj0rndal L, Rei Dige I, Nyvad E EM, Wennstror adults: randomi and direct pulp 118, 290-7. Reprinted with per International Endodontic Journal, 39, 785-790, 2006 © 2006 International Endodontic Journal
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FACULTY OF HEALTH SCIENCES UNIVERSI
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I. /l { Endodontic treatment: reaso
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CONTENTS Preface ..................
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Preface The present dissertation ha
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INCLUDED PUBLICATIONS I. Bj0rndal L
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:mt or treat apical Jmplicated, suc
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)ically based on 1988, Odesjo et 1i
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years of age. The 7 to 1.96. Concom
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of tooth treated, the naire also as
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1agement for caries ie for inclusio
Page 21 and 22:
ast one year after he primary outco
Page 23 and 24:
h retaining pulp vitality gnificant
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1ge between 92% and n et al. 1990),
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were randomly selected at that time
Page 29 and 30: VJ): 11 complications' occurred >rr
Page 31 and 32: ished in a lower number techniques
Page 33 and 34: 32 GDP:= - = Decisive influence 100
Page 35 and 36: table 10. In the 'technical -fillin
Page 37 and 38: iquency ;urance register containing
Page 39 and 40: ita from 1997 and 2003 tas 6.5% for
Page 41 and 42: ~mphasizes the importance pulp vita
Page 43 and 44: to impair the endodontic 1ay also t
Page 45 and 46: ced at both universities in ins to
Page 47 and 48: ind female patients were s of the p
Page 49 and 50: e rates obtained amongst may be dif
Page 51 and 52: English summary There is a great di
Page 53 and 54: follow-up, and the vast tors shapin
Page 55 and 56: Dansk resume lnden for endodontisk
Page 57 and 58: 1g blev udf0rt (62.4%). f0rt, havde
Page 59 and 60: References Allard U, Palmqvist S (1
Page 61 and 62: ution of methods to 1ational Journa
Page 63 and 64: and quality of root -:Jontic Journa
Page 65 and 66: lontic treatment, d adult, general
Page 67 and 68: 1alence of apical ics and Dental ~-
Page 69 and 70: Bj¢rndal & Reit Endodontic treatme
Page 75 and 76: ppendix II Bj0rndal L, Laustsen MH,
Page 77 and 78: Reasons for root canal treatment Bj
Page 79: Reasons for root canal treatment Bj
Page 83 and 84: ~ "'l'J/lli'l!{JjtflFfl[;Ofi'1tra a
Page 85 and 86: , caries in adults 291 I yr. With a
Page 87 and 88: 'I' caries in illf11/1s 293 vitalit
Page 89 and 90: J caries in adults 295 ncy' at J yr
Page 91 and 92: , caries in adults 297 !I Developme
Page 93 and 94: Bj¢rndal & Reit Adoption of new te
Page 99 and 100: ppendix Bj0rndal L, Laustsen MH, Re
Page 101 and 102: OOOOE Volume 103, Number 4 Bj¢mdal
Page 103 and 104: OOOOE Volume 103, Number 4 Bj¢mda!
Page 105 and 106: OOOOE Volume 103, Number 4 Bj¢mdal
Page 107 and 108: doi:lO. 1111/j. 1365-2591.2008.014
Page 109 and 110: BjPrndal & Reit Endodontic malpract
Page 111: Bf¢rndal & Reit Endodontic malprac
Page 114: FACULTY OF HEAL TH SCIENCES UNIVERS
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