Oral health-related quality of life and satisfaction after root canal treatment according to operator expertise: A longitudinal prospective study

Ibrahim Eid Alroudhan; Jothish Ravi; Shilpa Shaliputra Magar; Mohammad Khursheed Alam; Khalid Nafea Alsharari; Fadhel Musaad Alsharari

doi:10.4103/sej.sej_291_20

ORIGINAL ARTICLE

Year : 2021 | Volume : 11 | Issue : 3 | Page : 388-392

Oral health-related quality of life and satisfaction after root canal treatment according to operator expertise: A longitudinal prospective study

Ibrahim Eid Alroudhan, Jothish Ravi, Shilpa Shaliputra Magar, Mohammad Khursheed Alam, Khalid Nafea Alsharari, Fadhel Musaad Alsharari
Department of Preventive Dentistry, Jouf University, Sakaka, Jouf, Saudi Arabia

Date of Submission	08-Dec-2020
Date of Decision	22-Jan-2021
Date of Acceptance	09-Feb-2021
Date of Web Publication	3-Sep-2021

Correspondence Address:
Dr. Ibrahim Eid Alroudhan
Alfaysaliah, Al Sudairy St. Building No: 3299, Unit No: 21, Additional No: 9238, Postal Code: 72346, Sakaka, Jouf
Saudi Arabia

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/sej.sej_291_20

Abstract

Introduction: Although the success rate of conventional root canal treatment is 70%–95%, patient satisfaction varies depending on various factors. Patient satisfaction and quality of life (QOL) are suspected to differ depending on the level of operator expertise. We investigated factors affecting the QOL and satisfaction of patients after root canal treatment performed by students, postgraduates, and specialists.
Materials and Methods: The Oral Health Impact Profile survey (OHIP-17), seven semantic differential scales, and a radiographic assessment sheet were used in this study. The validity of the Arabic version of OHIP-17 was demonstrated by calculating the kappa statistic (0.95). The sample size was 250 patients; 63, 91, and 96 of whom were treated by specialists, graduates, and undergraduate students, respectively. Using the OHIP-17, an independent examiner interviewed each patient before and 2 weeks after treatment; patient satisfaction was assessed using a differential scale at the same time points. Radiographic assessments were conducted preoperatively and 2 weeks postoperatively by two independent radiographers.
Results: The responses to most OHIP-17 questions showed no significant differences pre- and post-treatment. However, three, four, and two items were significantly different pre- and post-treatment in the undergraduate, graduate, and specialist groups, respectively. A P < 0.05 was considered to be significant.
Conclusion: Root canal treatment improved the QOL of the patients. The findings will help dentists to understand patient perception and thus improve the holistic value of endodontic care.

Keywords: Endodontics, quality, root canal treatment, satisfaction, treatment

How to cite this article:
Alroudhan IE, Ravi J, Magar SS, Alam MK, Alsharari KN, Alsharari FM. Oral health-related quality of life and satisfaction after root canal treatment according to operator expertise: A longitudinal prospective study. Saudi Endod J 2021;11:388-92

How to cite this URL:
Alroudhan IE, Ravi J, Magar SS, Alam MK, Alsharari KN, Alsharari FM. Oral health-related quality of life and satisfaction after root canal treatment according to operator expertise: A longitudinal prospective study. Saudi Endod J [serial online] 2021 [cited 2023 Mar 29];11:388-92. Available from: https://www.saudiendodj.com/text.asp?2021/11/3/388/325405

Introduction

Pulpal exposure, related pathologies, and intentional therapy account for the overwhelming majority of root canal treatments.^[1],[2] With the increasing demand for endodontic therapy, the short- and long-term effects of root canal treatment on patient quality of life (QOL) and satisfaction should be taken into consideration.^[3],[4] Because tooth loss negatively affects the QOL, every measure should be expended to save the tooth before resorting to extraction.^[5],[6]

The success rate of conventional root canal treatment is 70%–95%.^[7] However, patient satisfaction varies according to operator knowledge,^[8] skill and technique, number of appointments, duration of appointments, and whether the main symptom (typically pain) is alleviated or recurs during (flare-up) or after (complication) treatment. Because of the way in which it is perceived and processed by the brain, pain can have a lasting psychological impact and induce fear of dental treatments.

The success of endodontic treatment is evaluated based on the clinical outcome (using radiographic criteria) and the short-term survival of the tooth.^[9],[10] However, these parameters alone are not sufficient to fully judge the treatment outcome.^[11] Patient-reported outcomes and satisfaction are becoming more important in modern dental practice as the patient-centered model is adopted.^[12] Moreover, patient satisfaction and QOL likely differ depending on operator expertise. The oral health-related QOL and satisfaction may be assessed using the Oral Health Impact Profile survey (OHIP-17), but studies with this instrument have focused on, for instance, malocclusion and caries.^{[13],[14],[15]}

We investigated the factors affecting the QOL and satisfaction of patients before and after root canal treatment performed by students, postgraduates, and specialists.

Materials and Methods

All patients referred for root canal treatment to the outpatient wing of the dental clinics in the College of Dentistry from August to February 2019 were eligible for this prospective longitudinal study. Ethical clearance was obtained from the Local Institutional Committee for Bioethics and Research (approval no. 9-16-8/39). Sample size was calculated using the method of Liu et al.;^[12] 250 patients were included in the study.

All patients 18–60 years of age who were medically and mentally fit to provide informed consent were included in the study. Patients with uncontrolled diabetes, hypertension, blood disorders, pregnancy, and undergoing orthodontic treatment and those with failed root canal-treated teeth indicated for retreatment were excluded from the study. Informed consent was obtained from all participants. Any participant who chose to withdraw from the study was allowed to do so without any consequences.

The OHIP-17 questionnaire, semantic differential scale, and radiographic assessment sheet were used.^[13] The validity of the Arabic version of the OHIP-17 was demonstrated by calculating the kappa statistic (0.95). Using the OHIP-17, an independent examiner interviewed each patient before and 2 weeks after treatment, and patient satisfaction was assessed using the differential scale 2 weeks after treatment. The association between the score given and the amount of improvement was evaluated by paired t-test and a post hoc test. Radiographic assessment was performed before and 2 weeks after treatment by two independent observers; a third observer resolved any disagreement. The associations between changes in oral health – as indicated by the Periapical Index (PAI) score, patient satisfaction, and OHIP-17 score – and QOL were evaluated.

Results

The sociodemographic characteristics of the 250 patients are listed in [Table 1]. The responses to several of the OHIP-17 [Table 2] items showed significant differences pre- and post-treatment. In the undergraduate group, can't go to work, avoid socializing, and lack of self-confidence were significantly different pre- and post-treatment. For the graduate group, four items showed significant differences pre- and post-treatment. For the specialist group, the responses for can't go to work and avoid socializing were significantly different pre- and post-treatment.

Table 1: Sociodemographic distribution of patients

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Table 2: Distribution of oral health impact profile survey-17 responses among participants

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The semantic differential scale comprises six items: price (1 = expensive and 10 = least expensive), time (1 = time consuming and 10 = quick), pain (1 = painful and 10 = painless), esthetics (1 = didn't improve esthetics and 10 = improved esthetics), chewing (1 = chewing difficult and 10 = improved chewing), and satisfaction (1 = unsatisfactory and 10 = satisfactory). The results are shown in [Table 3]. The radiographic assessment results and PAI scores are shown in [Table 4].

Table 3: Semantic differential scale results (after completion of root canal treatment)

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Table 4: Radiographic assessment and periapical index score represented in percentage

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A cross-tabulation test showed that most responses to the OHIP-17 items were significantly different between males and females. For example, the responses of males to the item moderate-to-severe inability to eat (physical pain) were 50.0% (never), 20.0% (occasionally), and 30.0% (often), compared to 7.1% (never) and 92.9% (occasionally) for females. Furthermore, the responses of males to the item difficulty speaking/pronunciation were 54.5% (often) and 45.5% (occasionally); by contrast, all of the females (100%) responded with “never.”

Two OHIP-17 items were significantly correlated with nonvital pulp, i.e., avoid socializing and lack of self-confidence, the mean values of which were 1.20 ± 0.09 and 1.60 ± 0.11 pretreatment and 1.40 ± 0.1 and 1.40 ± 0.18 posttreatment, respectively (P = 0.26 for both; paired sample t-test).

Discussion

To the best of our knowledge, no study to date has investigated the effect of root canal treatment on QOL in the Jouf region of Saudi Arabia. QOL reflects the patient's perception of the impact of an illness and its treatment.^[3]

A 2-week postoperative recall was used because postoperative pain peaks at 3–5 h and decreases thereafter.^[16] Pain severity decreases by 50% on day 1 after the procedure and by 90% on day 7. The frequency of persistent pain (≥6 months) is very low; 5% due to odontogenic and 3% due to nonendogenic causes.^[17] Therefore, in the majority of cases, pain no longer affects the QOL after 1 week. Liu et al.^[18] and Wigsten et al.^[19] recommend a 6-month recall to allow assessment of periradicular healing, which is incomplete after 2 weeks.^[20] However, qualitative clinical improvement is evident after 2 weeks; use of such a period also minimizes recall bias at the end of the procedure.

The taper of the preparation, the length and density of obturation, and the PAI score were higher for graduates and undergraduates than for specialists, who likely see more challenging cases. The majority of the cases with a high PAI score were treated by specialists and showed considerable improvement in 2 weeks with further improvements at 1, 3, and 6 months.

The OHIP-17 questionnaire^[12] includes 17 items under seven domains. In this study, pain on chewing, thermal provocation, dietary restriction, and difficulty in relaxing or focusing were the most common negative aspects.^[12],[18] With the exceptions of absence from work, inhibition to socialize, and lack of self-confidence, all domains showed a significant improvement in the three groups. Dissatisfaction could be caused by delayed final restoration,^[17] likely associated with discolored nonvital teeth. Sleep disturbance, which predominated in Vena et al.,^[21] had a significantly lesser effect in our study. The pretreatment values for all seven domains showed that pulpal disease and its consequences negatively influence a patient's QOL; the posttreatment values reflect treatment-induced improvement, and the mean difference is indicative of the impact of treatment. We found no significant difference in responses among the three groups; this is in agreement with Dugas et al.^[3] but not with Vena et al.^[21] Indeed, the patients treated by the specialists reported mild dissatisfaction, possibly as a result of the difficulty level of the cases, which might have necessitated longer appointments and multiple visits.^[20] We analyzed three levels of operator expertise to promote data heterogeneity. Pain and physical disability were more frequent in this study that in prior reports.^[3],[22]

We evaluated patient satisfaction using the semantic differential scale proposed by Hamasha.^[13] Dugas et al.^[3] and Al Habashneh et al.^[23] suggested that the most frequent cause of dissatisfaction is treatment cost. Furthermore, patients from a low socioeconomic background were dissatisfied primarily because they felt that treatment charges were unacceptably high. We could not evaluate the effect of treatment cost because the College of Dentistry clinics are free of charge. Educational background did not significantly affect patient satisfaction, likely because high school students, university students, and young adults are well informed about root canal treatment.^[24] Treatment time was one of the main reasons for dissatisfaction and could be ameliorated in selected cases by single-visit endodontics. Root canal treatment relieved pain and restored the chewing ability and esthetics in the majority of patients.

Overall satisfaction was low in the undergraduate group, possibly because the undergraduates were overly cautious and frequent interruptions by supervisors, resulting in a lack of patient confidence.

This study had several limitations: small sample size, subideal standardization, and short recall period. These could be rectified in further works by evaluating preoperative pulp status and retreatment cases and by comparing anterior-posterior teeth and postendodontic rehabilitation.

Conclusion

Within the limitations of this study, it can be concluded that root canal procedures improved the QOL. The findings will help dentists to understand patient perception and thus improve the holistic value of endodontic care.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Eckerbom M, Flygare L, Magnusson T. A 20-year follow-up study of endodontic variables and apical status in a Swedish population. Int Endod J 2007;40:940-8.
2.	Kirkevang LL, Vaeth M, Hörsted-Bindslev P, Wenzel A. Longitudinal study of periapical and endodontic status in a Danish population. Int Endod J 2006;39:100-7.
3.	Dugas NN, Lawrence HP, Teplitsky P, Friedman S. Quality of life and satisfaction outcomes of endodontic treatment. J Endod 2002;28:819-27.
4.	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.
5.	Gerritsen AE, Allen PF, Witter DJ, Bronkhorst EM, Creugers NH. Tooth loss and oral health-related quality of life: A systematic review and meta-analysis. Health Qual Life Outcomes 2010;8:126.
6.	Levin LG, Law AS, Holland GR, Abbott PV, Roda RS. Identify and define all diagnostic terms for pulpal health and disease states. J Endod 2009;35:1645-57.
7.	Weiger R, Axmann-Krcmar D, Löst C. Prognosis of conventional root canal treatment reconsidered. Endod Dent Traumatol 1998;14:1-9.
8.	Jamal M, Khawaja S, Chogle S. Awareness, attitude, and practice of regenerative endodontic procedures among clinicians from different dental specialties. Saudi Endod J 2020;10:137. [Full text]
9.	Ng YL, Mann V, Rahbaran S, Lewsey J, Gulabivala K. Outcome of primary root canal treatment: Systematic review of the literature-part 1. Effects of study characteristics on probability of success. Int Endod J 2007;40:921-39.
10.	Torabinejad M, Lozada J, Puterman I, White SN. Endodontic therapy or single tooth implant? A systematic review. J Calif Dent Assoc 2008;36:429-37.
11.	Allen PF. Assessment of oral health related quality of life. Health Qual Life Outcomes 2003;1:40.
12.	McGrath C, Bedi R. The value and use of 'quality of life' measures in the primary dental care setting. Prim Dent Care 1999;6:53-7.
13.	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.
14.	Slade GD. Assessing change in quality of life using the Oral Health Impact Profile. Community Dent Oral Epidemiol 1998;26:52-61.
15.	Bhaisare A, Patil A, Warhadpande M. Evaluation of oral health related quality of life and satisfaction outcome of endodontic treatment in central India-a cross sectional study. IOSR JDMS 2017;16:43-50.
16.	Christiansen R, Kirkevang LL, Hørsted-Bindslev P, Wenzel A. Patient discomfort following periapical surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:245-50.
17.	Nixdorf DR, Moana-Filho EJ, Law AS, McGuire LA, Hodges JS, John MT. Frequency of persistent tooth pain after root canal therapy: A systematic review and meta-analysis. J Endod 2010;36:224-30.
18.	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.
19.	Wigsten E, Kvist T, Jonasson P, Bjørndal L, Dawson VS, Fransson H, et al. Comparing quality of life of patients undergoing root canal treatment or tooth extraction. J Endod 2020;46:19-28.
20.	Molven O, Halse A, Grung B. Observer strategy and the radiographic classification of healing after endodontic surgery. Int J Oral Maxillofac Surg 1987;16:432-9.
21.	Vena DA, Collie D, Wu H, Gibbs JL, Broder HL, Curro FA, et al. Prevalence of persistent pain 3 to 5 years post primary root canal therapy and its impact on oral health-related quality of life: PEARL Network findings. J Endod 2014;40:1917-21.
22.	Montero J, Lorenzo B, Barrios R, Albaladejo A, Mirón Canelo JA, López-Valverde A. Patient-centered outcomes of root canal treatment: A cohort follow-up study. J Endod 2015;41:1456-61.
23.	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.
24.	Jothish R, Alam MK, Alam F. Impact of educational background on knowledge, attitude, and practice of root canal treatment among male university and high school students of Sakaka Province. Saudi Endod J 2019;9:101. [Full text]