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Year : 2016  |  Volume : 6  |  Issue : 1  |  Page : 21-25

Students' perception of multiple dental visits for root canal treatment: Questionnaire-based study

1 Department of Restorative Dental Science, King Saud University, Riyadh, Saudi Arabia
2 College of Dentistry, King Saud University, Riyadh, Saudi Arabia
3 Department of Periodontics and Community Dentistry, King Saud University, Riyadh, Saudi Arabia
4 College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

Date of Web Publication16-Dec-2015

Correspondence Address:
Reem Siraj Alsulaimani
King Saud University, P. O. Box 60169, Riyadh 11545
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1658-5984.171999

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Introduction: Root canal treatment (RCT) is a meticulous procedure that requires focus and precision while working in a confined space such as the root canal system of the tooth. Hence, it is a challenging practice for dental students a questionnaire-based study was conducted to evaluate senior dental students' perception toward single- and multiple-visit RCT while considering tooth type and patient cooperation, and to identify the most common reasons for multiple-visit RCT. Materials and Methods: This cross-sectional study included 267 senior year dental students from three universities and one private college in Saudi Arabia. A self-administered questionnaire was distributed between May and October 2014. The questionnaire was divided into four main sections, which evaluated student perception regarding single- and multiple-visit treatment, patient cooperation, and the nontherapeutic reasons for multiple-visits treatment. The collected data were analyzed using SAS 9.3. Results: Two hundred and seventeen questionnaires were returned (response rate, 81%). Dental students perceive multiple-visit RCT for anterior and premolar teeth as a significantly more stressful event than multiple-visit RCT for molars (P < 0.0001; Bowker's test). Tooth type and patient medical status were the highest ranked reasons for multiple-visit RCT. The majority of the responders (90%) considered single-visit RCT for single-rooted teeth a positive practice. Conclusions: Multiple-visit RCT is a stressful event for dental students, especially if the treated tooth was a single-rooted tooth. Dental students are aware of the negative effect of multiple-visit treatment on patient compliance. Clinical training should consider single-visit treatment for single rooted teeth.

Keywords: Dental education, endodontics, multiple-visit, patient cooperation, single-visit

How to cite this article:
Alsulaimani RS, Al-Manei K, Baras B, Alaqeely R, El Metwally A, Ashri N. Students' perception of multiple dental visits for root canal treatment: Questionnaire-based study. Saudi Endod J 2016;6:21-5

How to cite this URL:
Alsulaimani RS, Al-Manei K, Baras B, Alaqeely R, El Metwally A, Ashri N. Students' perception of multiple dental visits for root canal treatment: Questionnaire-based study. Saudi Endod J [serial online] 2016 [cited 2023 Feb 1];6:21-5. Available from: https://www.saudiendodj.com/text.asp?2016/6/1/21/171999

  Introduction Top

Root canal treatment (RCT) is a meticulous procedure that requires focus and precision while working in a confined space such as the root canal system of the tooth.[1] Therefore, clinical-training places emphasis on teaching students the application and the execution of fine psychomotor skills such as working with indirect vision, controlling high-speed motor-driven burs during access cavity preparation, and fine tactile sensation during root canal preparation.[2] The effect of such training on dental students while managing patient pain and inquiries is an important aspect to consider during curriculum assessment.

In general, supervising faculties assess the case difficulty before students can begin treatment. In addition, faculties check treatment progress frequently, both clinically and radiographically.[3] Radiographic documentation of RCT is widely used and is considered an accepted practice in endodontic clinical training.[4],[5] It allows students and supervising faculties to discuss and evaluate treatment progress. Therefore, supervision and frequent radiographic documentation are extra steps found in a dental student clinic, which are absent from specialist or general clinics.[6] The effect of such an educational setup on the established rapport between the patient and dental student and its contribution in multiple-visit RCT is an important aspect that needs evaluation.

In general, dental patients prefer to complete RCT in the least number of visits to avoid changes in lifestyle and reparative postoperative pain.[7],[8] This preference increases in elderly patients and patients with a complex medical history.

On the other hand, dental practitioners prefer multiple-visit RCTs.[9],[10] The popularity of multiple-visit RCT is mainly based on the use of intra-canal medicament to control microbial infection within the canal.[11] However, the current trend indicates that more than 50% of dental practitioners do not use intra-canal medicament in multiple-visit RCT.[6] Moreover, multiple-visit RCT in clinical training is unavoidable owing to insufficient operator skills and/or limited patient cooperation.

Dental students' manual skills are challenged more during the treatment of molars, which are multi-rooted teeth as compared to anterior and premolar teeth. Molar teeth have a more complex root canal system and limited working field;[1] therefore, tooth type and position in the dental arch were one of the factors used by the American Association of Endodontics during case-difficulty assessment. For that reason, a significant association between tooth type and multiple-visit RCT was anticipated during clinical training. However, such correlations have not being previously reported in dental education.

The objectives of this questionnaire-based study were:

  • To evaluate dental students' perception toward single- and multiple-visit RCT while considering tooth type and patient cooperation
  • To identify the most common nontherapeutic reasons of multiple-visit RCT in dental students clinics.

  Materials and Methods Top

Study participants

This study involved senior-year students from Bachelor of Dental Science Programs in Saudi Arabia; their participation was voluntary. Inclusion criteria for the students were as follows: Two years of endodontic training and proven experience of having treated at least five patients during their clinical training. In 2014, a total of 267 questionnaires were distributed [Figure 1] among Senior Dental Students at King Saud University (Central Province), Riyadh College for Dentistry and Pharmacology (Central Province), King Abdulaziz University (Western Province), and King Faisal University (Eastern Province). This research has obtained ethical clearance from the Institutional Review Board and Ethical Approval Committee at the College of Dentistry, King Saud University (KSU).
Figure 1: Questionnaire distribution among senior dental students in Saudi Arabia (KSU: King Saud University, RCDP: Riyadh College of Dentistry and Pharmacology, KAU: King Abdulaziz University, KFU: King Faisal University)

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Questionnaire development and validation

To the best of our knowledge, this is the first study that aimed to evaluate student perception toward multiple-visit RCT. Therefore, the study questionnaire was piloted and tested among five KSU senior students. The eight questions were phrased to hold the participant's attention, and the four sections were clear and concise. The questionnaire was distributed in person or through E-mail [Figure 2] and collected by two KSU senior students to ensure a high response rate.[12]
Figure 2: The mode of questionnaire distribution among senior dental students in Saudi Arabia (KSU: King Saud University, RCDP: Riyadh College of Dentistry and Pharmacology, KAU: King Abdulaziz University, KFU: King Faisal University)

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Study questionnaire

A self-administered questionnaire was developed to identify dental students' perception toward the number of visits in endodontic treatment. Multiple-visit endodontic treatment was defined as treatment requiring more than three dental visits to complete the RCT in one tooth by the same student in the designated dental school. A dental visit was defined as a student-patient encounter for more than 30 min. Endodontic clinical training lasted for at least 1-year in the included institutes.

The questionnaire was divided into four sections. The first section evaluated the perceptions of dental students on multiple-visit endodontic treatment while considering tooth type. The responses to select from were as follows: Stressful (causes mental or emotional stress to the practitioner), insignificant (unnoticeable event to the practitioner), and positive (does not cause mental or emotional stress to the practitioner). The second section evaluated the relationship between multiple-visit RCT and patient cooperation. The responses to select from were as follows: Decreased patient cooperation to attend dental visits, did not affect patient cooperation, or increased patient cooperation. The third section ranked the reasons behind multiple-visit RCT. The mentioned reasons were tooth type, radiographic documentation, patient medical status, and supervising faculty. The final section was to evaluate the students' perception regarding the treatment of a single-rooted tooth in a single-visit. The responses to select from were as follows: Stressful, insignificant, or positive.

Statistical analysis

Descriptive statistical analysis and Bowker's test using SAS 9.3 (SAS Institute, Cary, NC, USA) were performed to determine if there was a difference in the perception of stress and patient cooperation during single- and multiple-visit RCT. P < 0.05 indicated the level of significance. In addition, statistical analysis was used to measure the mean and standard deviation of the reasons behind multiple-visit RCT, and to rank them accordingly.

  Results Top

A total of 217 questionnaires were returned [Figure 1] within the period from May to October 2014 with a response rate of 81% (217/267).

Dental students' perception toward multiple-visit root canal treatment

Multiple-visit RCT for single-rooted teeth was regarded as stressful by 50% (109/217), normal by 28% (60/217), and insignificant by 22% (48/217) of respondents. On the other hand, multiple-visit RCT for multi-rooted teeth was viewed as normal by 51% (110/217), stressful by 37% (81/217), and insignificant by 12% (26/217) of the respondents. Multiple-visit RCT for single-rooted teeth was significantly more stressful to students than multiple-visit treatment for multi-rooted teeth (P < 0.0001; Bowker's test).

Multiple-visit root canal treatment and patient cooperation

Multiple-visit RCTs for single-rooted teeth were considered as a reason to decrease patient cooperation by 74% (160/217) of the respondents. The remaining viewed it as a reason to increase patient cooperation 15% (32/217), or not affecting patient cooperation 11% (25/217). The patient cooperation in multiple-visit RCTs for multi-rooted teeth was regarded as decreased by 63% (136/217), not affected by 26% (57/217), and increased by 11% (24/217) of the respondents. Multiple-visit RCT for single-rooted teeth significantly reduced patient cooperation (P < 0.0001; Bowker's test) when compared to multiple-visit RCT for multi-rooted teeth.

Nontherapeutic reasons for multiple-visit root canal treatment

Tooth type was the first reason for multiple-visit RCT, followed by patient medical status and radiographic documentation. Supervising faculty was ranked as the least important reason leading to multiple-visit endodontic treatment. The average ranking is presented in [Table 1].
Table 1: Ranking of reasons leading to multiple-visit root canal treatment

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The main reason for stressful multiple-visit RCT of single-rooted teeth was tooth type (average rank ± standard deviation: 1.92 ± 0.87), followed by radiographic documentation (2.47 ± 1.01), patient medical status (2.56 ± 1.33), and supervising faculty (3.01 ± 0.91).

However, the main reason for stressful multiple-visit RCTs of multi-rooted teeth was patient medical status (2.09 ± 1.32), followed by tooth type (2.14 ± 0.88), radiographic documentation (2.85 ± 1.12), and supervising faculty (2.93 ± 0.82).

Perception toward treating single-rooted teeth in a single-visit

Among the 217 respondents, 195 (90%) viewed single-visit treatment for single-rooted teeth as a positive practice. Eleven (5%) respondents regarded it as insignificant, and another 11 (5%) viewed it as stressful.

  Discussion Top

Questionnaire-based studies are practical and allow information gathering from a large number of people in a short span of time and in a relatively cost-effective manner. In addition, questionnaires can be carried out by any number of people with limited effect on the study's validity and reliability.[13],[14] In this study, two senior dental students from King Saud University distributed the questionnaires either personally or through E-mail. Having the questionnaire distributed by a peer to the target group facilitated communication and resulted in high response rate. The nonrespondents (19% of the initial study population) declined participation in the study. Therefore, the response rate in this study was high due to good communication with the study target and the use of a multimode approach.[15]

Students' feedback is a valuable tool during the update of curriculum contents. Questionnaire studies are propping tools that can be used by educators to assess student perception before implementing new course objectives. Educators should always construct the clinical course to maximize the benefit of the student learning experience while maintaining patient cooperation.

As we mentioned earlier, single-visit RCT is an acceptable procedure for both single-rooted, as well as multi-rooted teeth.[9],[10] To deliver this information and revise training guidelines, we should first understand how students perceive multiple-visit RCTs. The major findings of this study are that dental students perceive multiple-visit RCTs as a stressful event regardless of the tooth type, because it reduces patient cooperation. Clinical training and the concern of maintaining patient compliance to attend dental visits has been recognized as a stressful event by dental students in Saudi Arabia.[16]

Literature about the perceptions of students regarding multiple-visit endodontics is scarce; however, there are some reports on the pros and cons of single- and multiple-visit endodontics.

A study was conducted in Australia among 52 endodontists about the perception of single- and multiple-visit root canals. The endodontists documented that they preferred multiple visits to a single-visit even when there were no medical concerns and the choice of treatment depended upon the operator's preference and not on the patient's medical concerns.[9] The pros and cons of single- versus multiple-visit RCTs have been debatable over the past several years. Both endodontists and patients have different reasons for favoring one over the other. In 2012, a study conducted at the University of Iowa documented that 78% of 124 patients preferred single-visit RCTs, yet many would favor multiple visits if the success rate of multiple visits were higher than that of a single-visit.[8] In the present study, students also preferred a single-visit to multiple visits; according to them, patient cooperation decreased, and stress level increased, with increased number of visits, especially for the treatment of single-rooted teeth.

Students participating in the current study reported that tooth type was an important reason along with patient medical status for multiple visits. A study conducted on special-needs patients in Australia documented that 69.1% specialist practitioners undertook single-visit root canal, and among general dentists, 75.7% opted for extraction in preference to RCT.[17] Another study in Brazil reported that the need for single or multiple visits mainly depends upon tooth vitality, and the success rate of both is comparable.[18] However, a single-visit saves the patient's time and has good acceptance from the patient. Nevertheless, reasons such as pain, swelling, and tooth structure demand for multiple visits.[19] Different studies have reported different views. This study evaluated the perceptions of dental students on multiple-visit endodontic treatment while considering tooth type, and how that affects patient cooperation. Thus, we cannot compare these perceptions with the perception of endodontists and patients who had experienced RCT done by a specialist, as treatment techniques depend on personal experience and feasibility. However, the literature suggests that there is a shift of preference toward single-visit RCT.[8]

This questionnaire-based study was limited to senior Saudi dental students. However, to the best of our knowledge, this is the first study to document dental students' perception toward multiple-visit RCT and its effect on patient cooperation. Therefore, the focus should be made on such strategies that can be helpful in making the multiple visits comfortable for patients.

To maximize the benefits of single-visit RCT, such practice needs to be introduced in the preclinical training of dental students'. Moreover, students should be informed with the objectives and rationale of including single-visit RCT. Accordingly, the supervisory faculty can motivate them to fulfill the intended learning outcome of endodontic clinical training.

Based on the results from this study, we can advise educators to encourage single-visit RCT in single-rooted teeth to maintain patient compliance and decrease the level of stress experienced by the students during multiple-visit endodontic treatment.

  Conclusion Top

Multiple-visit RCT is a stressful event for dental students especially if the treated tooth were single-rooted such as anterior and premolar teeth. Dental students are aware of the negative effect of multiple-visit treatment on patient compliance. Clinical training should consider single-visit treatment for single-rooted teeth.


We would like to thank the students for their participation and the staff at College of Dentistry Research Centre at King Saud University for their continuous support.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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  [Figure 1], [Figure 2]

  [Table 1]


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