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Year : 2021  |  Volume : 11  |  Issue : 3  |  Page : 334-338

The effect of root canal treatment on oral health-related quality of life: Clinical trial

1 Preventive Dentistry, Faculty of Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia
2 Endodontic Department, Umm Al-Qura University, Makkah, Saudi Arabia
3 Preventive Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia

Date of Submission26-Jun-2020
Date of Decision13-Jul-2020
Date of Acceptance23-Sep-2020
Date of Web Publication3-Sep-2021

Correspondence Address:
Dr. Abdulsamad Turki Ezzat
Preventive Dentistry, Faculty of Dentistry, Umm Al-Qura University, Makkah
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sej.sej_148_20

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Introduction: The awareness of patient-centered outcomes regarding the sequel of endodontic therapy in everyday life is limited. This study aimed to quantify the impact of root canal treatment in one visit compared to root canal treatment in multiple visits on oral health-related quality of life (OHRQoL).
Material and Methods: This is a controlled clinical trial, in which 32 patients were included; the age range was 16–60 years. At the patient's convenience, participants were divided into two groups: the first group received a single-visit treatment and the other group received a multiple-visit treatment. Conventional endodontic treatment was performed for indicated teeth by undergraduate dental students in a single visit or multiple visits. OHRQoL was recorded using an Arabic Oral Health Impact Profile (OHIP) questionnaire.
Results: A total of 32 patients, with a mean age of 30.5 (SD = 8.2), received root canal treatments and filled OHIP questionnaire. Male patients composed 50% of the sample. The majority of the patients had a high school education (75%). Single-visit root canal treatment significantly improved OHRQoL by 7.6 points (P = 0.001) and multiple visits by 8 points (P = 0.001).
Conclusion: Both single and multiple visits endodontic treatments equally improved OHRQoL.

Keywords: Multiple-visit, oral health impact profile, Oral related quality of life, root number, single-visit

How to cite this article:
Ezzat AT, Nagro AF, Fawzy AT, Bukhari OM. The effect of root canal treatment on oral health-related quality of life: Clinical trial. Saudi Endod J 2021;11:334-8

How to cite this URL:
Ezzat AT, Nagro AF, Fawzy AT, Bukhari OM. The effect of root canal treatment on oral health-related quality of life: Clinical trial. Saudi Endod J [serial online] 2021 [cited 2023 Mar 30];11:334-8. Available from: https://www.saudiendodj.com/text.asp?2021/11/3/334/325388

  Introduction Top

Natural dentition must always be preserved because nothing appears, feels, or functions like a natural tooth.[1] There has been a growing interest in assessing the impact of health on the quality of life to help understanding the effects of health problems and how treatment may change the lives of patients.[2],[3] The oral health impact profile (OHIP), designed by Slade and Spencer in 1994, is a well-established tool for assessing oral health-related quality of life (OHRQoL).[4] OHRQoL considered being an integral part of the evaluation of the effects of oral problems and the assessment of clinical outcomes.[2.3] OHIP questionnaire, which is made to measure seven concepts, which are as follows: functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap. This measurement aims to give a good assessment of the oral condition and needs.[5] Since then, OHIP-14 has been built as a short form, consisting of 14 statements that basically record the critical aspects of the complete version of OHIP.[6] In the scope of endodontics, researches used the short-form OHIP-14 and have shown that pulpal disease may have an influence on the reported OHRQoL.[3],[7],[8] In fact, the aspects of physical pain have been found to influence the patient perception of their OHRQoL. In 6-month follow-up, the researchers were able to show the improvement of OHRQoL after the root canal procedures.[8] There was a systemic review that discussed pain severity and prevalence after, before, and during root canal treatment. They found that the pain associated with pulpal involvement was severe and declined to moderate within 1 day and reduced to minimal after 7 days.[9] Considering the limited knowledge on the influence of endodontic treatment on the everyday lives of patients, the goal of this research was to measure the impact of root canal treatment on OHRQoL in one visit relative to root canal treatment at multiple visits.

  Material and Methods Top

This study was established in a dental teaching hospital, Makkah, Saudi Arabia, from the beginning of September 2019 to the end of January 2020. The institutional review board (IRB) approved the study protocol (IRB number: 132-19). The present study is a clinical trial, in which participants received root canal treatment in single or multiple visits, and OHRQoL was measured by asking the subjects to complete an Arabic version of OHIP-14 questionnaire [Table 1]{Table 1}.

To detect a difference in mean changes of 8.0 in OHIP scores with a standard deviation (SD) of 6.0 with 82% power and alpha of 0.05, sample sizes of 16 subjects per group were included.[10] Consequently, a convenience sample of 32 patients was included; age ranged from 16 to 60 years and all needed root canal treatment. To reduce selction bias, mixed-effect models were used. Patients diagnosed with symptomatic irreversible pulpitis and normal periapical tissue were included in the study. Cases with calcified canals, systemic diseases that may complicate root canal treatment such as endocarditis, or any kind of resorption were excluded from the study.

After consent form was signed and research purposes were clarified to the participant, an interview form was created and followed to reduce information bias. To quantify OHRQoL and to verify sociodemographic factors, the questionnaire was delivered through face-to-face interview. Each question in the OHIP-14 has a code: (zero mean never, one mean hardly ever, two mean occasionally, three mean fairly often, and four mean very often). OHIP-14 score was calculated by summing up the scores of 14 questions, ranging from 0 to 56, then using it as an indicator of the severity of the impact on OHRQoL. The higher the score, the greater the negative impact.[11] The patients were assigned randomly into two groups of fifty patients each. In the single-visit group, patients filled out the OHIP questionnaire twice, at the beginning of the treatment, and at the second follow-up visit after obturation. For the multiple visits group, the OHIP questionnaire was filled three times, in the beginning, the next visit after access cavity and pulp extirpation, and after obturation.

Local anesthesia (articaine 4% with epinephrine 1/100,000, Septodont, saint-maur-des-fossés, France) was administrated. Then, conventional endodontic treatment was performed for indicated tooth by undergraduate dental students in a single or multiple visits. Rubber dam medium thickness (Dentsply Sirona, Ballaigues, Switzerland) was used to isolate the indicated tooth. The working length was determined with an apex locator (DentaPort ZX Apex Locator, MORITA, Kyoto City, Japan) by a size 10 K-file, and a periapical X-ray was taken to confirm the working length. Irrigation was performed by a disposable plastic syringe and a 30G endodontic needle with 5% sodium hypochlorite. Root canal preparation was performed by the ProTaper NEXT nickel–titanium rotary system (X Smart Plus, Dentsply Sirona, Ballaigues, Switzerland). Ethylenediametetracetic acid was used as a conditioner for the root canal (Dentsply sirona, Ballaigues, Switzerland). Root canal filling was completed with gutta-percha points (Dentsply sirona, Ballaigues, Switzerland) and resin-based root canal sealer (ADSEAL, META BIOMED, Chungcheongbuk-do, South Korea). In multiple visit treatment, intracanal medication (Metapaste-Calcium Hydroxide with Barium Sulfate, META BIOMED, Chungcheongbuk-do, South Korea) was used between the visits. The access cavity was sealed with temporary filling between the visits. To reduce operator bias, two undergraduate students with similar performance, based on their clinical performance in the endodontics course, were selected to execute the treatments under the supervision of a single endodontist.

For inferential statistics, multivariable mixed-effect linear regression model was developed to prognosticate total OHIP-14 scores while adjusting for potential confounders. In addition, after inspecting within-subject covariance matrix, decided to use unstructured within-subject covariance. STATA software (version 14.1; Stata, College Station, TX) was used for all statistics. Statistical tests were two-tailed and interpreted at the 0.05 significance level.

  Results Top

The mean age of males was 30.5 (SD = 8.2) years and females was 32.9 (SD = 9.5) years. Endodontic treatment in the single visit was conducted on eight males, and eight females and the multiple visit treatment was conducted on eight males and eight females. The social status of 53% of the sample was single and 46% married. The educational level of the sample population was 75% with a high school degree and 25% with a bachelor's degree. The general health was self-assessed and 84% reported that they were in good general health. The percentage of smokers was 31% [Table 2]{Table 2}.

Multivariable statistical analysis revealed that the OHIP of both groups increased after treatment protocol compared to the baseline. The difference between the first visit and second visit shows a significant improvement in OHIP in both single-visit randomized controlled trial (RCT) and multiple-visits RCT [Figure 1]. However, in the case of multiple-visits RCT, the difference between the second visit and the third visit showed nonsignificant improvement [Table 3]. Single-visit protocol improved OHIP, on average, by 7.6 points (P = 0.001). The multivisit protocol (before extirpation vs. after extirpation) improved OHIP by 8 points (P = 0.001) and the multivisit protocol (after extirpation vs. after obturation) improved OHIP by 1.3 points (P = 0.436). However, when both protocols were compared to each other, there was no statistical significance among them [Table 2]
Figure 1: The diffrence in oral health impact profile between single-visit randomized controlled trial and multiple-visits randomized controlled trial

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{Table 3}.

  Discussion Top

Quality of life in modern public health research and practice is generally accepted as a valid, effective, and important measure of service demands and outcomes of intervention. The present study relates the quality of life and satisfaction of patients with their root canal treatment. There was a significant increase in OHRQoL after the treatment with single and multiple visits. However, there was no significant difference if the procedure was conducted in a single visit or multiple visits.

The OHIP-14 questionnaire used in this study was adopted from previous studies.[6],[11] The English version was translated to Arabic. They were linguistically and culturally adapted, so the enrolled patients can understand the question.

The results of the present study confirmed other clinical studies, which concluded that satisfaction degree among patients has the negative correlation with pain score.[12],[13] Those studies found that the prevalence of postoperative pain after single-visit treatment and multiple visit treatment has no significant difference.

Torabinejad et al. have studied patient satisfaction after endodontic treatment and have concluded that feeling pain during endodontic treatment decreases patient satisfaction with a large degree.[14] A significant improvement in OHIP-14 after endodontic treatment was found in a prospective longitudinal study done by Liu et al.[8] One research attempted to determine the quality of life and patient satisfaction with endodontic treatment done by undergraduates, postgraduates, and endodontic specialists in a longitudinal study.[15] They found that patients had a greater satisfaction with their endodontic therapy done by professionals, followed by postgraduates and then undergraduates, mainly due to shorter treatment time.

In single visit treatment, saving time is important, and the root canal treatment is provided with the option of giving anesthetics only once.[16] Although treatment can be performed in one visit, all essential interventions such as thorough cleaning, biomechanical preparation, and disinfection must be completed along with obturation. Single-visit treatment is contraindicated for nonvital teeth and teeth with acute inflammation.[17] In addition, patients with the inability to tolerate extended periods during treatment and/or temporomandibular disorders may not be appropriate for root canal treatment in a single visit.

Endodontic treatment of vital pulp teeth usually eliminates acute symptoms led to the improvement of the quality of life more than it did with nonvital pulp teeth. Furthermore, the oral health has the same effect, so in case of poor oral health, more improvement was noticed.[15] Hence, in this study, the oral health of the participant was similar to each other to make sure that there is no other contributing factor which may affect the final result.

This study was limited to healthy patients and from a single community. A larger-scale study of the same objective needs to be conducted to see whether any other factors may influence this result such as whether the patient suffered from any long-term disability or illness.

  Conclusion Top

OHRQoL was improved after endodontic treatment, but there was no significant difference in whether the treatment was done in a single visit or multiple visits.


We would like to thank our Faculty of Dentistry, Umm Al-Qura University; we cannot even express enough our gratitude for giving us this opportunity to work in their clinic! We would also like to thank Dr. Rola Al Habashneh for collaborating with us and giving us a copy of the approved OHIP-14 Arabic version.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

American Association of Endodontists. Chicago: Saving Your Natural Tooth. Available form: https://www.aae.org/patients/root-canal-treatment/saving-natural-tooth/. [Last accessed on 2020 Apr 18].  Back to cited text no. 1
Gherunpong S, Sheiham A, Tsakos G. A sociodental approach to assessing children's oral health needs: Integrating an oral health-related quality of life (OHRQoL) measure into oral health service planning. Bull World Health Organ 2006;84:36-42.  Back to cited text no. 2
Liu P, McGrath C, Cheung G. What are the key endodontic factors associated with oral health–related quality of life? Int Endod J 2014;47:238-45. Available from: https://doi.org/10.1111/iej0.12139. [Last accessed on 2020 Apr 18].  Back to cited text no. 3
Slade GD, Spencer AJ. Development and evaluation of the oral health impact profile. Community Dent Health 1994;11:3-11.  Back to cited text no. 4
Slade GD. Assessing change in quality of life using the oral health impact profile. Community Dent Oral Epidemiol 1998;26:52-61.  Back to cited text no. 5
Slade GD. Derivation and validation of a short-form oral health impact profile. Community Dent Oral Epidemiol 1997;25:284-90. Available from: https://doi.org/10.1111/j. 1600-0528.1997.tb00941.x. [Last accessed on 2020 Apr 18].  Back to cited text no. 6
Liu P, McGrath C, Cheung GS. Quality of life and psychological well-being among endodontic patients: A case-control study. Aust Dent J 2012;57:493-7.  Back to cited text no. 7
Liu P, McGrath C, Cheung GS. Improvement in oral health-related quality of life after endodontic treatment: A prospective longitudinal study. J Endod 2014;40:805-10.  Back to cited text no. 8
Pak JG, Fayazi S, White SN. Prevalence of periapical radiolucency and root canal treatment: A systematic review of cross-sectional studies. J Endod 2012;38:1170-6.  Back to cited text no. 9
Rosner B. Fundamentals of Biostatistics. Boston: Brooks/Cole, Cengage Learning; 2011.  Back to cited text no. 10
Al Habashneh R, Khader YS, Salameh S. Use of the Arabic version of oral health impact profile-14 to evaluate the impact of periodontal disease on oral health-related quality of life among Jordanian adults. J Oral Sci 2012;54:113-20.  Back to cited text no. 11
Wong AW, Zhang S, Li SK, Zhu X, Zhang C, Chu CH. Incidence of post-obturation pain after single-visit versus multiple-visit non-surgical endodontic treatments. BMC Oral Health 2015;15:96.  Back to cited text no. 12
Wong AW, Tsang CS, Zhang S, Li KY, Zhang C, Chu CH. Treatment outcomes of single-visit versus multiple-visit non-surgical endodontic therapy: A randomised clinical trial. BMC Oral Health 2015;15:162.  Back to cited text no. 13
Torabinejad M, Salha W, Lozada JL, Hung YL, Garbacea A. Degree of patient pain, complications, and satisfaction after root canal treatment or a single implant: A preliminary prospective investigation. J Endod 2014;40:1940-5.  Back to cited text no. 14
Hamasha AA, Hatiwsh A. Quality of life and satisfaction of patients after nonsurgical primary root canal treatment provided by undergraduate students, graduate students and endodontic specialists. Int Endod J 2013;46:1131-9.  Back to cited text no. 15
Al-Rahabi M, Abdulkhayum A. Single visit root canal treatment: Review. Saudi Endod J 2012;2:80-4.  Back to cited text no. 16
  [Full text]  
Rudner WL, Oliet S. Single-visit endodontics: A concept and a clinical study. Compend Contin Educ Dent 1981;2:63-8.  Back to cited text no. 17


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