title: Quality of life of endodontically treated versus implant treated patients: a University-based qualitative research study. Prevalence of and factors affecting post-obturation pain in patients undergoing root canal treatment. Endodontic patient profile of Hacettepe University, Faculty of Dentistry in Ankara, Turkey. Postoperative Pain after Root Canal Treatment: A Prospective Cohort Study A prospective randomized double-blind trial on efficacy of dexamethasone for endodontic interappointment pain in teeth with asymptomatic inflamed pulps. A prospective study of the factors affecting outcomes of non-surgical root canal treatment: part 2: tooth survival. A prospective clinical evaluation of different single-tooth restoration designs on osseointegrated implants. A 3-year follow-up of Brånemark implants. Effect of prophylactic amoxicillin on endodontic flare-up in asymptomatic, necrotic teeth. Fear of blood, injury, and injections, and its relationship to dental anxiety and probability of avoiding dental treatment among 18-year-olds in Norway. Quality of life and satisfaction of patients after nonsurgical primary root canal treatment provided by undergraduate students, graduate students and endodontic specialists. Predicting dental avoidance among dentally fearful Australian adults. The effect of the Relaxodont brain wave synchronizer on endodontic anxiety: evaluation by galvanic skin resistance, pulse rate, physical reactions, and questionnaire responses. Reducing fear of pain associated with endodontic therapy. Pain associated with root canal treatment. Randomised controlled trial of music on state anxiety and physiological indices in patients undergoing root canal treatment.
abstract: INTRODUCTION Up-to- date studies comparing endodontic treatment versus implant-supported prosthesis have shown similar clinical outcome and survival rates . However , no data are available comparing both treatment modalities based on the patient 's perception of quality of life . This study was design ed to qualitatively describe and compare the quality of life of patients with restored , single endodontically treated teeth versus patients with single implant-supported fixed prostheses . METHODS Forty-eight patients agreed to participate in the study ( n = 24 from each treatment modality ) . Of those , 37 actually participated in the study : 17 were endodontically treated and 20 had an implant-supported prosthesis . Patients in each of the two groups were r and omly selected from the Graduate Endodontics and Graduate Periodontics Departments , respectively . Six focus group discussion s ( n = 3 per treatment group ) were held and audio-recorded for subsequent thematic analysis . Data were analyzed to identify common themes within each category and compared to assess any differences in quality of life between the two treatments . Additionally , a quality of life survey , the shortened version of the Oral Health Impact Profile ( OHIP-14 ) , was given before the discussion group and the responses analyzed . RESULTS The results obtained from this study show similar overall OHIP scores and show a high rate of satisfaction with both treatment modalities . Content analysis of the discussion groups revealed several themes and subthemes . The major themes were importance of overall health , financial implication s of the treatments , perception of the treatments and its outcomes , time since treatment , and follow-up dental visits . CONCLUSIONS The results help identify patients ' perception and concerns with each treatment modality and assist the clinician and patient in the selection of an optimal treatment for their given situation . In addition to the prognosis and outcomes , clinicians should consider patients ' perceptions and preferences as well as the influence each therapy may have on their quality of life , both short- and long-term . Overall , all the participants in this study were pleased with the treatment received and expressed a clear message to save their natural dentition whenever possible AIM This longitudinal , prospect i ve study ( 1 ) investigated the prevalence of post-obturation pain after root canal treatment  and ( 2 ) evaluated the influence of factors affecting the pain experience . METHODOLOGY Twenty practitioners , comprising general dental practitioners , MSc graduates and Endodontists , participated in this study . The patient sample ( n = 415 ) was derived from consecutive patients attending the practitioners ' surgeries for root canal treatment on a single tooth . Demographic , medical history , preoperative and intra-operative data as well as  pain experience on day 1 and day 2 after root canal obturation were recorded . Intensity of pain experienced was recorded on a visual analogue scale ( VAS ) of 0 - 5 . The data were analysed using logistic regression models . RESULTS The prevalence of post-obturation pain within 48 h after treatment was 40.2 % ( n = 167 ) but less than 12 % of patients experienced severe pain ( VAS 4 or 5 ) on either day 1 or day 2 . The factors that significantly influenced post-obturation pain experience were : gender ( OR = 0.434 , P < 0.001 ) , tooth type ( OR = 1.733 , P = 0.007 ) , size of periapical lesion ( OR = 0.493 , P = 0.004 ) , history of post-preparation pain ( OR = 4.110 , P = < 0.001 ) or generalized swelling ( OR = 3.435 , P = 0.005 ) and number of treatment visits ( OR = 2.604 , P < 0.001 ) . CONCLUSIONS The prevalence of post-obturation pain was high ( 40.2 % ) . The important prognostic determinants of post-obturation pain were female , molar tooth , size of periapical lesion smaller than 3 mm , history of post-preparation pain or generalized swelling and single-visit treatment AIM To assess previous patient experience of endodontic treatment  and to quantify their satisfaction with the endodontic treatment provided in a dental school clinic . DESIGN Self-completed question naire . SETTING Hacettepe University , Faculty of Dentistry , Department of Endodontics , Ankara , Turkey . PARTICIPANTS 200 r and omly selected , scheduled non-emergency patients in good health and older than 11 years who were to be treated by undergraduate , graduate students and academics . MAIN OUTCOME MEASURES Patient satisfaction and attitudes to root canal therapy .  RESULTS 96 per cent of patients , regardless their level of education , age and sex , reported that they expected RCT would save their teeth . 15 per cent of the patients were in favour of extraction versus RCT  before the therapy , but this reduced to only 2.5 per cent post treatment . 82 per cent of patients reported that they were satisfied with their treatment and the clinic . CONCLUSIONS Increasing public knowledge of and interest in endodontic treatment indicates that the need for an increase in teaching of the subject and associated re sources will be required Aim . To evaluate the incidence and severity of  postendodontic treatment pain ( PEP ) subsequent to root canal treatment ( RCT )  in vital and necrotic pulps and after retreatment . Methodology . A prospect i ve study . Participants were all patients ( n = 274 ) who underwent RCT in teeth with vital pulp , necrotic pulp , or vital pulp that had been treated for symptomatic irreversible pulpitis or who received root canal retreatment , by one clinician , during an eight-month period . Exclusion criteria were swelling , purulence , and antibiotic use during initial treatment . A structured question naire accessed age , gender , tooth location , and pulpal diagnosis . Within 24 h of treatment , patients were asked to grade their pain at 6 and 18 hours posttreatment , using a 1–5 point scale . Results . RCT of teeth with vital pulp induced a significantly higher incidence and severity of PEP ( 63.8 % ; 2.46 ± 1.4 , resp . ) than RCT of teeth with necrotic pulp ( 38.5 % ; 1.78 ± 1.2 , resp . ) or of retreated teeth ( 48.8 % ; 1.89 ± 1.1 , resp . ) . No statistical relation was found between type of pain ( spontaneous or stimulated ) and pulp condition . Conclusion . RCT of teeth with vital pulp induced a significantly higher incidence and intensity of PEP compared to teeth with necrotic pulp or retreated teeth To determine whether a relatively large dose of oral dexamethasone given for a short period of time would be effective in reducing endodontic interappointment pain , the current double-blind , placebo-controlled study was undertaken . After the visit for instrumentation , 40 patients with asymptomatic teeth having vital-inflamed pulps were r and omly given either dexamethasone ( 3 tablets of 4 mg each ) or a dextrose placebo identical in appearance ( same dosage schedule ) . The outcome showed that the oral administration of dexamethasone result ed in a statistically significant reduction in endodontic interappointment pain at all three time periods evaluated , that is , at 8 hours , 24 hours , and 48 hours ( p less than 0.01 ) . It appears from the results of this study that this dosage schedule of oral dexamethasone is sufficient to significantly reduce endodontic interappointment pain for teeth with asymptomatic vital-inflamed pulps . Further studies are needed for teeth with other endodontic pulpal-periapical conditions and for symptomatic teeth AIM To investigate the probability of and factors influencing tooth survival  following primary ( 1 ° RCT x ) or secondary ( 2 ° RCT x ) root canal treatment .  METHODOLOGY This prospect i ve study involved annual follow-up of 2 ( 100 % ) to 4 years ( 50 % ) of 1 ° RCT x ( 759 teeth , 572 patients ) and 2 ° RCT x ( 858 teeth , 642 patients ) carried out by Endodontic postgraduate students . Pre- , intra- and post-operative data were collected prospect ively from consented patients . Information about extraction of the root filled tooth was sought from the patient , the referring dentist or derived from the patient 's records and included the timing and reasons for extraction . Tooth survival was estimated and prognostic factors were investigated using Cox regression . Clustering effects within patients were adjusted in all models using robust st and ard error . RESULTS The 4-year cumulative tooth survival following 1 ° RCT x [ 95.4 % ( 93.6 % , 96.8 % ) ] or 2 ° RCT x [ 95.3 % ( 93.6 % , 96.5 % ) ] was similar . Thirteen prognostic factors were identified . Significant patient factors included history of diabetes and systemic steroid therapy . Significant pre-operative factors included narrow but deep periodontal probing depth ; pain ; discharging sinus ; and iatrogenic perforation ( for 2 ° RCT x cases only ) . Significant intra-operative factors included iatrogenic perforation ; patency at apical terminus ; and extrusion of root fillings . Significant post-operative restorative factors included  presence of cast restoration versus temporary restoration ; presence of cast post and core ; proximal contacts with both mesial and distal adjacent teeth ; and terminal location of the tooth . The presence of pre-operative pain had a profound effect on tooth loss within the first 22 months after treatment [ hazard ratio ( HR ) = 3.1 ; P = 0.001 ] with a lesser effect beyond 22 months ( HR = 2.4 ; P = 0.01 ) . Patency at the apical terminus reduced tooth loss ( HR = 0.3 ; P < 0.01 ) within the first 22 months after treatment but had no significant effect on tooth survival beyond 22 months . Extrusion of gutta-percha root filling did not have any effect on tooth survival ( HR = 1.1 ; P = 0.2 ) within the first 22 months but significantly increased the hazard of tooth loss beyond 22 months ( HR = 3.0 ; P = 0.003 ) . CONCLUSIONS The 4-year tooth survival following primary or secondary root canal treatment was 95 % , with thirteen prognostic factors common to both Since single-tooth implant restorations were introduced 12 years ago ( Jemt 1986 ) , there has been continuous development both in the technical design and the aesthetic outcome of the treatment . In order to ensure high quality in single-tooth implant treatments a clinical follow-up study was carried out on patients treated with modifications to the original regimen . In this study 69 consecutive patients were provided with 80 single-tooth implant restorations .  The patients were followed for 3 years . There was continuous development of the prosthetic design during the time of the study , allowing us to analyse possible prognostic differences for the different prosthetic treatments . This study confirms earlier reports which describe the single-tooth implant treatment as a safe method with few surgical complications and minimal marginal bone loss . Only 1 implant was lost during the follow-up period and the average marginal bone loss was 0.48 mm over the 3-year follow-up period . Crowns veneered with acrylic and with gold casted directly to the abutments , screwed onto the implants , led to recurring prosthetic complications and gave an appearance of rapid ageing . The first generation of crowns made following the Cera-One design , sometimes produced a gap between the crown and the abutment associated with significant marginal bone loss during the first year . Few surgical or prosthetic complications were noted with cemented all-ceramic constructions , although the number of these crowns in this study was limited The purpose of this prospect i ve , r and omized , double-blind , placebo-controlled study was to determine the effect of prophylactic amoxicillin on the occurrence of endodontic flare-up in asymptomatic , necrotic teeth . Seventy patients participated and had a clinical diagnosis of an asymptomatic , necrotic tooth with associated periapical radiolucency . One hour before endodontic treatment , patients r and omly received either 3 g of amoxicillin or 3 g of a placebo control in a double-blind manner . After endodontic treatment , each patient received : ibuprofen ; acetaminophen with codeine ( 30 mg ) ; and a 5 1/2-day  diary  to record pain , swelling , percussion pain , and number and type of pain medication taken . The results demonstrated 10 % of the 70 patients had a flare-up characterized by moderate-to-severe postoperative pain or swelling that began approximately 30 h after endodontic treatment and persisted for an average of 74 h. Of the seven patients who had flare-ups , 4 were in the amoxicillin group and 3 were not . Prophylactic amoxicillin did not significantly ( p = 0.80 ) influence the endodontic flare-up . We concluded that a prophylactic dose of amoxicillin before endodontic treatment of asymptomatic , necrotic teeth had no effect on the endodontic flare-up BACKGROUND More knowledge about the relationship between blood-injury-injection phobia ( BIIP ) and dental anxiety ( DA ) may give new clinical ly relevant information in the assessment and management of children with DA . OBJECTIVE The aims of this study were to explore the relationships between BIIP and DA , and to explore to what extent the two subtypes of BIIP in combination with DA are related to self-reported probability of avoiding dental treatment if a dental injection is needed . METHODS The subjects were a r and om sample of 1385 18-year-olds attending high schools in a county of Norway , and the data were collected by use of question naires completed in classrooms . The survey instruments applied were  Dental Fear Survey , Injection Phobia Scale-Anxiety , and Mutilation Question naire . RESULTS About 11 % of the subjects with DA and subtypes of BIIP , respectively , reported high probability of avoiding dental treatment in a situation where a dental injection was possibly needed . In multiple regression analysis , only DA contributed to self-reports of high probability of avoiding dental treatment . CONCLUSION The results indicate that among adolescents , BIIP is relatively often connected with DA . Clinical implication s are discussed AIM ( i ) To assess the impact of  primary root canal treatment  on the perceived quality of life amongst a cohort of Jordanian patients , ( ii ) to assess this cohort 's satisfaction of their primary root canal treatment , and ( iii ) to evaluate the association of the level of training and experience of clinicians with these two parameters . METHODOLOGY A systematic r and om sample of 302 subjects was selected from patients who attended undergraduate , graduate and specialty clinics of Jordan University of Science and Technology . Participants were interviewed before and two weeks after completion of root canal treatment . The study instrument included the Oral Health Impact Profile question naire ( Dugas et al. 2002 ) and seven semantic differential scales . Data analyses included descriptive statistics and nonparametric analyses . RESULTS More than 90 % of subjects reported improvements in the sense of taste , pain , eating , altering food temperature , self-consciousness , waking up during sleep , interruption of meals , difficulty to relax and difficulty to sleep after root canal treatment . There was no significant difference in terms of improvement amongst patients treated by specialists , graduate students or undergraduate students . The overall semantic differential score of intraoperative pain , pleasantness , chewing ability and general satisfaction was about 8 . Satisfaction of root canal treatment by specialists was higher in terms of time involved , intraoperative pain , pleasantness and general satisfaction than those treatments by undergraduate students . Patients treated by specialist were least satisfied with the treatment cost compared to those patients treated by graduate or undergraduate students . CONCLUSIONS The impact of root canal treatment on the quality of life was apparent . Satisfaction with root canal treatment approximates 8 on the semantic differential scale with preference for specialists over dental students Dental fear is related to poorer oral health outcomes , and this might be explained by the less frequent dental visiting of many fearful people . The objectives of this study were to investigate differences between dentally fearful people who regularly attend the dentist and fearful people who infrequently visit the dentist . A r and om sample of 1,082 Australians ≥ 15 yr of age completed a mailed question naire ( response rate = 71.6 % ) , and 191 dentate , high-fear adults ( ≥ 18 yr of age ) were selected for further analysis . Dental avoidance was recorded if a person was currently avoiding or delaying dental care and if he/she had not been to a dentist in the previous 2 yr . Among the selected dentally fearful adults , dental avoidance was predicted by smoking status , toothbrushing frequency , coping strategy use , perceptions of dental visits as uncontrollable and unpredictable , and by anxiety relating to numbness , not knowing what the dentist is going to do , and cost . In a multivariate logistic regression model , smoking , toothbrushing , coping , and anxiety about numbness and cost remained as statistically significant predictors , with the model accounting for 30 % of the variance . While several variables were associated with dental avoidance  among fearful adults , the nature and causal directions of these associations remain to be established The effects of a brain wave synchronizer ( BWS ) on endodontic ( root canal ) anxiety  was evaluated in the clinical practice s of the senior author . The experimental groups were : ( 1 ) a verbal method ( routine calming words by dentist ) plus BWS ( N = 10 ) and ( 2 ) verbal method plus BWS and alpha relaxation tape ( N = 10 ) . The control group was verbal method alone ( N = 10 ) . All three groups were evaluated during a complete endodontic treatment by the use of galvanic skin resistance ( GSR ) , pulse rate ( PR ) , physical responses , and pre- and post-treatment question naires . Recordings were made during the following periods : ( 1 ) start ; ( 2 ) local anesthetic injection ; ( 3 ) rubber dam application ; ( 4 ) drilling ; ( 5 ) x-ray taking ; ( 6 ) instrumentation ; ( 7 ) obturation ; and ( 8) conclusion . Results showed that the experimental groups were significantly better than the control group in the reduction of endodontic anxiety . The findings reinforced the belief that local anesthetic injection is the most anxiety producing aspect of endodontic treatment AIM To provide subjects with positive information about  endodontic treatment ( ET )  to reduce fear of pain associated with ET . METHODOLOGY A large sample ( n = 437 ) was r and omly allocated to read one of five informative paragraphs and afterwards asked to complete two question naires ( dental anxiety and fear of dental pain ) . The paragraphs consisted of dental information obtained from patient brochures . One ( experimental ) paragraph consisted of positive information about  pain  during ET . Analysis of variance followed by post hoc analysis was used to detect differences in mean score . RESULTS Subjects who were given the positive information regarding ET indicated they were less fearful of pain associated with ET . CONCLUSIONS The clinical implication of this experiment is that patients should be accurately informed about pain associated with ET . In this way , the patient may be more at ease before and during treatment , decrease avoidance behaviour and make decisions regarding treatment choice , based on common sense rather than fearful expectations AIM To determine the pain experienced by patients during root canal treatment  and to correlate with age and gender , pulpal diagnosis , previous periapical status , dental characteristics and length of treatment . METHODOLOGY One hundred and seventy-six patients ( 68 men and 108 women ) , with ages ranged from 6 to 83 years , were r and omly recruited . Patients completed a 10-cm visual analogue scale ( VAS )  that ranked the level of pain experienced during root canal treatment . RESULTS The mean pain level during root canal treatment was 1.2 + /- 0.8 in a VAS between 0 and 10 . Fifty-four per cent of patients did not experience pain . There were no significant differences in relation to gender or age groups . M and ibular teeth had a significantly ( P < 0.05 ) higher percentage incidence of pain in comparison with maxillary teeth . Pain was absent in 63 % of anterior teeth compared with 44 % in posterior ones ( P < 0.01 ) . Interventions shorter than 45 min result ed in a significantly higher percentage of pain absence ( P < 0.05 ) .  Root canal treatment  was significantly ( P < 0.05 ) more painful in teeth with irreversible pulpitis and acute apical periodontitis compared to the group with necrotic pulps and chronic apical periodontitis ( P = 0.049 ) . CONCLUSIONS Root canal treatment in teeth with irreversible pulpitis and acute apical periodontitis was more painful . Age , tooth type and length of the treatment were factors associated with increased risk for pain experienced during the procedure . Knowledge of pain levels endured by patients will allow dentists to decide when to use supplemental local anaesthesia OBJECTIVES The purpose of this r and omised investigator-blind controlled trial is to examine the effects of music on the state anxiety and physiological indices among patients undergoing root canal treatment . DESIGN R and omised controlled trial . METHODS Purposive sampling was used to recruit 44 adult subjects . The subjects were r and omly assigned to the treatment and the control group . There were 22 subjects in each group . Subjects in the music group listened to selected sedative music using headphones throughout the root canal treatment procedure . The control group subjects worn headphones but without the music . Using a repeated measures design with a single pretest and five posttests , the subjects ' heart rate , blood pressure and finger temperature were measured before the study and every 10 minutes until the end of the root canal treatment procedure . Anxiety was measured before the study and at the end of the treatment procedure . RESULTS The results revealed that there were no significant differences between the two groups for baseline data and procedure-related characteristics , except for gender . However , the subjects in the music group showed a significant increase in finger temperature and a decrease in anxiety score over time compared with the control group . The effect size for state anxiety and finger temperature was 0.34 and 0.14 respectively . RELEVANCE TO CLINICAL PRACTICE The findings provide evidence for nurses and dentists that the use of soothing music for anxiety reduction in patients undergoing root canal treatment procedures is supported by research findings
target: RESULTS Application of the Oral Health Impact Profile ( OHIP ) demonstrated that disease of pulpal origin affects quality of life with moderate severity , primarily through physical pain and psychological discomfort , and that RCT results in broad improvement of quality of life .
  Satisfaction with RCT is extremely high , but cost is the primary reason for dissatisfaction .
  Anxiety and fear affect RCT patients , profoundly influencing their behaviors , including treatment avoidance , and their pain experience .
  Fear of pain is " fair " to " very much " prior to RCT .
  Pain is widely feared , disliked , and remembered ; however , disease of pulpal origin generally produces moderate , but not severe pain .
  RCT causes a dramatic decrease in pain prevalence and severity over the week following treatment .
  Survival rates of teeth after RCT are very high ; complication rates are low .
  Cost is a barrier to RCT , but initial costs , lifetime costs , cost effectiveness , cost utility , and cost benefit all compare extremely well to the alternatives involving replacement using implants or fixed prostheses .
background: INTRODUCTION Root canal treatment ( RCT ) success criteria inform us of the path to bony healing and of prognostic factors , but tell little about how the patient perceives , feels , or values RCT .
  Patients choose , undergo , and pay for RCT , they live with the result , and inform their community .
  The purpose of this narrative review was to appraise patient-centered outcomes of initial non-surgical RCT and nonsurgical retreatment , in adults .