Apical periodontitis (AP) is a common dental problem and can be treated by root canal treatment (RoCT) or extraction.  The aim of this survey for to explore patients’ preferences for management of a tooth affected by AP, when considering its retention via RoCT, its extraction without replacement, or its replacement with an implant supported crown (ISC), fixed partial denture (FPD) or removable partial denture (RPD).

A questionnaire piloted on university patients was mailed out to 800 randomly selected university patients. This was supplemented by a convenience sample (n=200) in 10 local dental practices.  The questionnaire focused on questions defined as the general preference for saving a tooth (anterior and posterior) with AP or extraction and the specific preference for tooth retention via RCT or extraction. For those who preferred extraction, preference for no replacement or replacement with RPD, FPD, or ISC was explored. The Gelberg-Andersen Behavioral Model for Vulnerable Populations was used to understand the influential factors

• The response rate was 43%  (434 out of 1000)
• The majority reported a general preference for treatment and retention over extraction at a significantly higher rate for anterior than for posterior teeth (97.2% and 89.6%, respectively; Fisher exact test, P = .003).
• The majority reported a specific preference for RCT over extraction, which also differed significantly for anterior and posterior teeth (93.7% and 83.8%, respectively; Fisher exact test, P < .005).
• Replacement was uniformly preferred for an anterior tooth, 27 of 69 participants (39%) preferred to not replace a posterior tooth.
• To replace an anterior tooth, ISC was the most preferred option reported by 21 of 27 participants (77%), with less preference for RPD (19%) and FPD (4%).
• To replace a posterior tooth, ISC was preferred by 28 of 69 participants (41%), with less preference for RPD (12%) and FPD (8%).
• Higher annual income, previous RoCT, functional dentition, good/excellent self-rated oral health, and regular dental visits were associated with higher preferences for tooth retention in response to different questions.

The authors concluded

The high preference for retaining a tooth in general was moderated by the specific consideration of RoCT to retain the tooth. When RoCT and extraction are viable options, patients should be advised about the treatment options in an impartial manner and encouraged to communicate their preferences.

Comment

There is increasing interested in understanding the patients  values an perspective relating to specific elements of treatment.  As this group have also surveyed dentists’ opinions on the treatment of AP  (Azarpazhooh et al) it is interesting to compare the two studies.  One noted by the authors was that none of the dentists preferred extraction of a posterior tooth without replacement, suggesting that dentists may be disposed to provide treatment for any edentulism, anterior and posterior alike.  As with most questionnaire survey non-response bias could be an issue. The sample was randomised and the authors considered it to be representative of a university clinic-base population and the additional convenience sample was included to increase generalisability, but these results may not be transferable to other populations.

Links

Azarpazhooh A, Dao T, Figueiredo R, Krahn M, Friedman S. A survey of patients’ preferences for the treatment of teeth with apical periodontitis. J Endod. 2013 Dec;39(12):1534-41. doi: 10.1016/j.joen.2013.07.012. Epub 2013 Sep 6. PubMed PMID: 24238442.

Azarpazhooh A, Dao T, Figueiredo R, Krahn M, Friedman S. A survey of dentists’ preferences for the treatment of teeth with apical periodontitis. J Endod. 2013 Oct;39(10):1226-33. doi: 10.1016/j.joen.2013.06.023. PubMed PMID: 24041382.