Home Print this page Email this page Users Online: 618
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 11  |  Issue : 2  |  Page : 168-172

Attitudes and practices regarding infection control during root canal treatment among dental practitioners in Saudi Arabia: A cross-sectional study


Department of Restorative Dental Sciences, College of Dentistry, Majmaah University, Al-Majmaah, Saudi Arabia

Date of Submission20-Jul-2020
Date of Decision03-Sep-2020
Date of Acceptance23-Sep-2020
Date of Web Publication8-May-2021

Correspondence Address:
Dr. Riyadh Alroomy
Department of Restorative Dental Sciences, College of Dentistry, Majmaah University, Al-Majmaah 11952
Saudi Arabia
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sej.sej_195_20

Rights and Permissions
  Abstract 

Introduction: The aseptic measures regarding infection control during root canal treatment are very important. The aim of this study is to assess the attitudes and practices regarding infection control during root canal treatment among dental practitioners in Saudi Arabia.
Materials and Methods: Four hundred questionnaires were sent electronically using Twitter and WhatsApp. The questionnaire composed of 17 questions. It was composed of four descriptive questions, five attitude-related questions, and eight practice-related questions. The target subjects were endodontists, Saudi Board in Restorative Dentistry (SBRD) specialists, Pedodontists, their specialty residents, general dentists, and interns. All data were subjected to statistical tests, and a value of P < 0.05 was considered statistically significant.
Results: The total number of participants was 327 (82%). There was an overall positive attitude (4.05/5) regarding the importance of infection control. Rubber dam isolation with saliva ejector was the most frequently reported method among Endodontic residents 51 (100%) and SBRD residents 24 (100%) (P = 0.022). Most of the respondents who reported not disinfecting the operative field were Endodontic residents 18 (35.3%) (P = 0.021). The majority of those who reported practicing glove changing before obturation were SBRD residents 14 (58.3%) (P = 0.001). The majority of those who reported gutta-percha disinfection before obturation were Endodontists 49 (90.7%) (P = 0.000).
Conclusion: This study showed that dental practitioners in Saudi Arabia were adherent in following the infection control measures during the treatment by self-reported attitudes and practices.

Keywords: Attitude, endodontics, infection control, root canal therapy, rubber dams


How to cite this article:
Alroomy R. Attitudes and practices regarding infection control during root canal treatment among dental practitioners in Saudi Arabia: A cross-sectional study. Saudi Endod J 2021;11:168-72

How to cite this URL:
Alroomy R. Attitudes and practices regarding infection control during root canal treatment among dental practitioners in Saudi Arabia: A cross-sectional study. Saudi Endod J [serial online] 2021 [cited 2021 Jun 17];11:168-72. Available from: https://www.saudiendodj.com/text.asp?2021/11/2/168/315645


  Introduction Top


The main goal in the success of the endodontic treatment is to prevent and cure apical periodontitis.[1] Multiple bacterial flora in the root canal system is one of the main factors in the failure of root canal treatment.[2] One of the methods to reduce microbial contamination during root canal treatment is the use of rubber dam.[3] The predictability of endodontic treatment and its prognosis depends on appropriate treatment modalities.[4] Highly favorable prognosis of root canal treatment was observed in university-based studies, wherein specialists supervised treatment application by graduate students.[4],[5] Nevertheless, a study reported that general dentists have a lower success rate in performing root canal treatment than specialists,[6] which may be due to general dentists failing to adhere to the standards of root canal treatment.[7],[8]

A recent study on the success rate of root canal treatment performed by Endodontic postgraduate students in Saudi Arabia was found to have favorable outcomes.[9] Previous research in Saudi Arabia reported low use of rubber dam during root canal therapy by general dentists (3.0%–56.3%).[10],[11],[12],[13] From previous research, it could be speculated that a high rate of failure results from improper isolation. Furthermore, it has been shown that the infected root canal is not only associated patient's bacteria but also with exogenous cause, which indicates contamination during the root canal treatment.[14] Therefore, this survey explores the aseptic measures performed during root canal therapy, such as disinfecting the operating field, type of disinfecting solution, changing the gloves, reusing the endodontic files, and disinfecting the gutta-percha. The aim of this study is to assess the attitudes and practices of infection control during root canal treatment among dental practitioners in Saudi Arabia.


  Materials and Methods Top


The Majmaah University for Research Ethics Committee (MUREC) has approved this research project MUREC-Apr. 29/COM-2020/28-4. In this cross-sectional study, 400 questionnaires were sent electronically using social media applications to participants in major cities in Saudi Arabia randomly. The questionnaire was composed of four descriptive questions, five attitude-related questions and eight practice-related questions. The followers of official twitter account for Saudi Dental specialties were searched for specialists, postgraduate students, general dentists, and interns. In addition, the principal investigator sent an invitation letter through multiple WhatsApp groups for different specialists. Prospective participants were informed that the completion of the web-based survey was voluntary. The participants were interns, general dentists, and specialists in Endodontics, Pedodontics, Saudi Board in Restorative Dentistry specialists, and postgraduate students of these specialties. All other specialties were excluded because they are not tasked with root canal treatment.

The questionnaire was distributed over a 2-month period May-June 2020. Normal distribution was assessed by the Shapiro–Wilk test. A two-tailed ANOVA test was used to compare average attitude scores according to the current job position. Post hoc Tukey's test was performed to identify which subgroup comparisons were statistically significant. Pearson's Chi-square (χ2) test was used to identify statistically significant associations between each subgroup and each question on practices of infection control during root canal treatment. The analyses were performed using IBM SPSS software (v. 26; IBM Corporation, Armonk, NY, USA) and a P < 0.05 was considered statistically significant.

The sample size was calculated based in the assumption that 50% of the subjects in the population have the factor of interest (Knowledge of infection control); thus, the study would require a sample size of: 385 for estimating the expected proportion with 5% absolute precision and 95% confidence. For the possibility of drop out (no response), the sample size was increased to 400. The following formulae were used to estimate the sample size:



Where z is the z score, ε is the margin of error, n is required sample size, and P is the assumed prevalence proportion.


  Results Top


The data were normally distributed, as indicated by a nonsignificant Shapiro–Wilk test (P > 0.05). Cronbach's alpha for reliability was found to be 0.83 and 0.87 for attitudes and practices, respectively. 327 (82%) of the participants completed the questionnaire. [Table 1] shows a largely positive attitude regarding infection control during root canal treatment. The average attitude score of the study population was 4.05/5, with subgroup scores ranging from 3.6 to 4.44.
Table 1: Participants' demographics and their characteristics

Click here to view


Attitudes

[Table 2] shows the participants' responses on a Likert scale of attitudes regarding infection control during root canal treatment. None of the participants disagreed/strongly disagreed on the importance of the rubber dam, while 281 (85.9%) of participants agreed/strongly agreed on the importance of disinfecting the operating field, and 129 (39.4%) agreed/strongly agreed that they disposed of endodontic files after a single use. Almost half of the participants 161 (49.2%) agreed/strongly agreed that they always changed their gloves before obturation. Almost two-thirds of the participants, 248 (75.8%) agreed on the importance of disinfecting the gutta-percha before obturation.
Table 2: Participants' attitude regarding infection control during root canal treatment

Click here to view


The general dentists had the least mean attitude toward isolation with rubber dam (P = 0.012). Pedodontic postgraduates had the least mean attitude towards disinfecting the operative field (P = 0.001) and also the least mean attitude towards disinfecting the gutta-percha before obturation (P = 0.000). All other attitude scores were not statistically significant

Practices

[Table 3] shows participants' practices regarding infection control during root canal treatment. The majority of participants 305 (93.3%) use a rubber dam and saliva ejector. In addition, 63 (19.3%) of participants did not disinfect the operative field. Only 53 (16.2%) dispose of the file after a single use. Some of the participants 114 (34.9%) did not change their gloves before obturation and other participants 69 (21%) did not disinfect the gutta-percha master cone before obturation. [Table 4] shows the most significant current job group with infection control practice.
Table 3: The participants' practices regarding infection control during root canal treatment

Click here to view
Table 4: Shows the most significant current job group with infection control practice during treatment

Click here to view



  Discussion Top


The study had a high response rate of 82%. The recruitment method used (i.e., Twitter and WhatsApp) to solicit participation was ultimately successful, perhaps because each participant had direct contact with the research team. Informed consent is not only voluntarily participation. It also includes type of question, compensation, risk and expected time needed. Al-Shahrani et al. used the WhatsApp to recruit participants and had a good response rate, so the same recruitment method was used in addition to Twitter.[15]

The research showed a positive attitude about the importance of preventing infections and contamination during root canal therapy. The overall practices, as presented in [Table 3], were deemed reasonable; however, when practices among subgroups were studied, inconsistency was found between them. This could be related to the variation in the subgroup sample sizes.

The majority of the participants used a combination of rubber dam and saliva ejectors (93.3%). This statistics is higher than that reported in previous studies of general dentists in Saudi Arabia (3%–56.3%).[11],[12],[13] The underlying reason for this discrepancy is believed to be due to the inclusion of specialists and residents in the current study. It is important to note that general dentists reported using rubber dam and saliva ejectors in accordance with Albahiti (82.5%).[16] The result of the previous study was higher than that of other studies because Albahiti investigated both the governmental and private sectors, finding that using a combination of rubber dam and saliva ejectors was higher in the governmental sector.[11],[12],[13],[16] This also could be related to the tremendous number of endodontic workshops held recently by endodontists in Saudi Arabia. Reports also suggested participating in continuing dental education motivated general dentists to use rubber dam.[10],[17]

The respondents who did not seal the gap during placement of rubber dam were Pedodontists and Pedodontic residents (59.3% and 64.7%, respectively). A study showed four-handed technique in Pedodontics provides good isolation moisture control.[18] This also explains why most of the respondents who used cotton rolls with saliva ejectors were pedodontists (18.5%).

The American Association of Endodontists and the European Society of Endodontology reported that the use of rubber dam is the standard of care for nonsurgical root canal treatment.[19],[20] Furthermore, European Society of Endodontology stated the tooth to be treated should be decontaminated before entering the pulp space.[20] Researchers have endorsed disinfecting the operative field using hydrogen peroxide and iodine, and they have encouraged its use during root canal treatment.[21] However, these two disinfecting solutions were the least frequently reported to be used in this study. Participants were more frequently used sodium hypochlorite, chlorhexidine, and alcohol. A previous study stated that the relative efficacy of various regimes remains uncertain.[22] A review evaluated previous research regarding disinfecting the operative field and concluded that there is no one study that provides complete asepsis; they further called into question the practicality of complete asepsis in daily practice.[23] This may explain why most of the respondents who do not disinfect the operative field were Endodontic residents.

It has been reported that changing gloves many times during treatment decreases the risk of root canal contamination.[24] Only one-third of the participants practice changing their gloves. Disinfecting the gutta-percha using rapid chairside disinfection by immersing the gutta-percha in NaOCl for 1 min has been found to be effective.[25] Most of the participants used this method, while some used different disinfecting solutions. The majority of the respondents who disinfected the gutta-percha were endodontists. A systematic review reported that autoclaving is the most effective method for endodontic instrument sterilization. Indeed, most of the participants reported using this method.[26]

One of the limitations of this study was the data were gathered through a questionnaire. Therefore, this study cannot conclude the self-reported practices accurately reflect actual practices. Studies have found discrepancies between self-reported and actual data.[27] Thus, observational studies are recommended to assess actual practice. This would be achieved in future studies by observing the practitioners directly under the nose of the study examiner during their practice.


  Conclusion Top


Within the limitation of the study, the attitudes and practices toward the importance of infection control during root canal treatment were satisfactory, although the practices of the subgroups varied. This study showed self-reported practices of the dental practitioners in Saudi Arabia were adherent in following the infection control during the treatment.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Trope M. The vital tooth– its importance in the study and practice of endodontics. Endod Top 2003;5:1-1.  Back to cited text no. 1
    
2.
Kakehashi S, Stanley HR, Fitzgerald RJ. The effects of surgical exposures of dental pulps in germ-free and conventional laboratory rats. Oral Surg Oral Med Oral Pathol 1965;20:340-9.  Back to cited text no. 2
    
3.
Cochran MA, Miller CH, Sheldrake MA. The efficacy of the rubber dam as a barrier to the spread of microorganisms during dental treatment. J Am Dent Assoc 1989;119:141-4.  Back to cited text no. 3
    
4.
Ng YL, Mann V, Gulabivala K. A prospective study of the factors affecting outcomes of nonsurgical root canal treatment: Part 1: Periapical health. Int Endod J 2011;44:583-609.  Back to cited text no. 4
    
5.
Friedman S, Abitbol S, Lawrence HP. Treatment outcome in endodontics: The Toronto study. Phase 1: Initial treatment. J Endod 2003;29:787-93.  Back to cited text no. 5
    
6.
Alley BS, Kitchens GG, Alley LW, Eleazer PD. A comparison of survival of teeth following endodontic treatment performed by general dentists or by specialists. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;98:115-8.  Back to cited text no. 6
    
7.
Unal GC, Kaya BU, Tac AG, Kececi AD. Survey of attitudes, materials and methods preferred in root canal therapy by general dental practice in Turkey: Part 1. Eur J Dent 2012;6:376-84.  Back to cited text no. 7
    
8.
Jenkins SM, Hayes SJ, Dummer PM. A study of endodontic treatment carried out in dental practice within the UK. Int Endod J 2001;34:16-22.  Back to cited text no. 8
    
9.
Muteq H, Al-Nazhan S, Al-Maflehi N. Outcomes of nonsurgical endodontic treatment among endodontic postgraduate students at Riyadh Elm University. Saudi Endod J 2020;10:7-14.  Back to cited text no. 9
  [Full text]  
10.
Iqbal A, Akbar I, Qureshi B, Sghaireen MG, Al-Omiri MK. A survey of standard protocols for endodontic treatment in North of KSA. ISRN Dent 2014;2014:865780.  Back to cited text no. 10
    
11.
Al-Fouzan KS. A survey of root canal treatment of molar teeth by general dental practitioners in private practice in Saudi Arabia. Saudi Dent J 2010;22:113-7.  Back to cited text no. 11
    
12.
Alrahabi M, Ahmad M. Knowledge regarding technical aspects of non-surgical root canal treatment in Al-Madinah Al-Munawarah private dental centers. Saudi Endod J 2015;5:155-60.  Back to cited text no. 12
  [Full text]  
13.
Bogari D, Alzebiani N, Mansouri R, Aljiaid F, Alghamdi M, Almalki M, et al. The knowledge and attitude of general dental practitioners toward the proper standards of care while managing endodontic patients in Saudi Arabia. Saudi Endod J 2019;9:40-50.  Back to cited text no. 13
  [Full text]  
14.
Vidana R, Sullivan A, Billström H, Ahlquist M, Lund B. Enterococcus faecalis infection in root canals-host-derived or exogenous source? Lett Appl Microbiol 2011;52:109-15.  Back to cited text no. 14
    
15.
Al-Shahrani M, Al-Qahtani SA, Al-Nefaie M, Al-Enezi G, Al-Nazhan S. Attitude and opinions of general dental practitioners, pedodontists, and endodontists toward regenerative endodontics in the Kingdom of Saudi Arabia. Saudi Endod J 2020;10:88.  Back to cited text no. 15
  [Full text]  
16.
Albahiti MH. Knowledge and practices of decontamination during root canal treatment by dentists in Jeddah. Saudi Dent J 2020;32:213-8.  Back to cited text no. 16
    
17.
Koshy S, Chandler NP. Use of rubber dam and its association with other endodontic procedures in New Zealand. N Z Dent J 2002;98:12-6.  Back to cited text no. 17
    
18.
Gary SK, Jones K, Malvitz DM, Gooch BF. Exploring four-handed delivery and retention of resin-based sealant. J Am Dent Assoc 2008;139:281-89.  Back to cited text no. 18
    
19.
American Association of Endodontists. American Association of Endodontists position statement: Dental dams. Am Assoc Endod 2017. Available from: https://www.aae.org/specialty/wp content/uploads/ sites/2/2017/06/dentaldamstatement.pdf. [Last accessed on 2020 Sep 13].  Back to cited text no. 19
    
20.
European Society of Endodontology. Quality guidelines for endodontic treatment: Consensus report of the European Society of Endodontology. Int Endod J 2006;39:921-30.  Back to cited text no. 20
    
21.
Möller AJ. Microbiological examination of root canals and periapical tissues of human teeth. Methodological studies. Odontol Tidskr 1966;74:Suppl: 1-380.  Back to cited text no. 21
    
22.
Ng YL, Spratt D, Sriskantharajah S, Gulabivala K. Evaluation of protocols for field decontamination before bacterial sampling of root canals for contemporary microbiology techniques. J Endod 2003;29:317-20.  Back to cited text no. 22
    
23.
Malmberg L, Björkner AE, Bergenholtz G. Establishment and maintenance of asepsis in endodontics – A review of the literature. Acta Odontol Scand 2016;74:431-5.  Back to cited text no. 23
    
24.
Niazi SA, Vincer L, Mannocci F. Glove contamination during endodontic treatment is one of the sources of nosocomial endodontic propionibacterium acnes infections. J Endod 2016;42:1202-11.  Back to cited text no. 24
    
25.
Cardoso CL, Kotaka CR, Redmerski R, Guilhermetti M, Queiroz AF. Rapid decontamination of gutta-percha cones with sodium hypochlorite. J Endod 1999;25:498-501.  Back to cited text no. 25
    
26.
Dioguardi M, Sovereto D, Illuzzi G, Laneve E, Raddato B, Arena C, et al. Management of instrument sterilization workflow in endodontics: A Systematic review and meta-analysis. Int J Dent 2020;2020:5824369.  Back to cited text no. 26
    
27.
Jenner EA, Fletcher BC, Watson P, Jones FA, Miller L, Scott GM. Discrepancy between self-reported and observed hand hygiene behaviour in healthcare professionals. J Hosp Infect 2006;63:418-22.  Back to cited text no. 27
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
References
Article Tables

 Article Access Statistics
    Viewed166    
    Printed0    
    Emailed0    
    PDF Downloaded43    
    Comments [Add]    

Recommend this journal