A Comparison of Endodontic Treatment Factors, Operator Difficulties, and Perceived Oral Health–related Quality of Life between Elderly and Young Patients

Introduction The purpose of this study was to compare endodontic treatment factors, treatment difficulties, and oral health–related quality of life (OHRQOL) between elderly and young patients. Methods A total of 150 adults, 75 elderly (≥65 years) and 75 young patients (18–64 years), were recruited. Operators enumerated difficulties associated with communication, diagnosis, rubber dam application, access cavity preparation, canal localization, working length determination, instrumentation, and obturation after root canal treatment. The number of treatment visits, maxillary first molars with a second mesiobuccal canal, and the technical quality of the root filling were registered. Patients filled out questionnaires on pain, attendance of regular dental visits, esthetics, and masticatory function and the Oral Health Impact Profile-14. Results Significantly more elderly had necrotic pulp (P < .001) and needed root canal treatment on teeth with full-coverage crown/bridge abutment (P < .001). It was significantly difficult to perform access cavity preparation and localize root canals on the elderly and on teeth with a full-coverage crown/bridge abutment. In regression analysis, the elderly presented with difficulties only during canal localization (P < .05). Second mesiobuccal canals were obturated in 43.5% of the young patients and 23.1% of the elderly patients. There were no significant differences in the number of treatment visits or the technical quality of root filling between the 2 groups. There were no significant differences in pain sensation, esthetics, masticatory function, or regular dental visits between the 2 groups. Elderly patients reported a significantly better OHRQOL (P < .05). Patients experiencing pain, patients needing treatment on anteriors/premolars, and females reported a significantly poorer OHRQOL (P < .05). Conclusions The elderly presented with treatment difficulty during canal localization and had better OHRQOL compared with young patients.publishedVersio

Impact of Case Difficulty, Endodontic Mishaps, and Instrumentation Method on Endodontic Treatment Outcome and Quality of Life: A Four-Year Follow-up Study

Introduction: Root canal treatment (RCT) is often considered a difficult procedure for both the patient and treatment provider. The American Association of Endodontists case difficulty assessment form categorizes cases as minimal, moderate, and high difficulty level. We recently showed that endodontic mishaps occur frequently during treatment of teeth in high difficulty category. The aims were to investigate the clinical and radiographic outcome at least 4 years after RCT and to evaluate patients’ perceived oral health-related quality of life (OHRQoL). Methods: Two hundred thirty-four patients (257 endodontically treated teeth) who were previously included in a quality assurance study were offered a recall appointment at the Department of Clinical Dentistry, University of Bergen, Norway. Patients were given a thorough clinical, radiographic examination and asked to fill out the Oral Health Impact Profile-14 questionnaire. Results: A total of 149 patients (160 teeth) attended the 4-year (range, 4–6 years) recall appointment. An unchanged or lower Periapical Index (PAI) score at recall visit was registered on 153 teeth (95.6%) (P < .001). Radiographic success rate (PAI score ≤ 2) was 87.5%, and clinical success (absence of clinical signs and symptoms) was 88.8%. Both radiographic and clinical success was observed in 78.8% of teeth. Teeth in high difficulty category, instrumented with engine-driven files, and molars presented with significantly more clinical signs and symptoms but not high PAI score (PAI score ≥ 3) (P < .05). Endodontic mishaps such as overinstrumentation and overfill with gutta-percha resulted in significantly high PAI score (P < .05). Patients with no clinical signs and symptoms after RCT and elderly had a significantly better OHRQoL (P < .05). Conclusions: Presence of clinical signs and symptoms rather than PAI score affected patients’ OHRQoL.publishedVersio

Influence of dental education on adoption and integration of technological aids in the delivery of endodontic care by dental practitioners: a survey

Objective To investigate adoption and integration of technological aids during endodontic treatment and where dental practitioners (DPs) learnt to use this technology. Materials and methods An electronic questionnaire was distributed to all 459 dentists who graduated from University of Bergen between 2008 and 2018. The respondents were divided into two cohorts, older graduates (2008–2013) and newer graduates(2014–2018). Results A total of 314(68.4%) DPs answered the questionnaire. Magnification in the form of dental operating microscopes (DOM) and dental loupes was used by 180 (59.6%), electronic apex locators (EAL) by 271(89.7%) and motor-driven files by 281 (93.4%) DPs. The most frequent response, as to where they learnt to use them was: during undergraduate dental (UG) education. Significantly more newer graduates (90.7%) performed instrumentation based on what they learnt during UG education (p < .001). Older graduates based their instrumentation method equally on what they learnt during UG education (51.9%) and continuing dental education(42.6%). Rubber dam was used during all treatment procedures by 93% of the DPs. Conclusions UG education is a communication channel with long-lasting importance for adoption and integration of technology by DPs. Exposure to innovations (awareness) during UG education is adequate for integration of technology. Continuing dental education is as valuable as UG education for adoption of technology for older graduates.publishedVersio

A Comparison of Endodontic Treatment Factors, Operator Difficulties, and Perceived Oral Health–related Quality of Life between Elderly and Young Patients

Introduction The purpose of this study was to compare endodontic treatment factors, treatment difficulties, and oral health–related quality of life (OHRQOL) between elderly and young patients. Methods A total of 150 adults, 75 elderly (≥65 years) and 75 young patients (18–64 years), were recruited. Operators enumerated difficulties associated with communication, diagnosis, rubber dam application, access cavity preparation, canal localization, working length determination, instrumentation, and obturation after root canal treatment. The number of treatment visits, maxillary first molars with a second mesiobuccal canal, and the technical quality of the root filling were registered. Patients filled out questionnaires on pain, attendance of regular dental visits, esthetics, and masticatory function and the Oral Health Impact Profile-14. Results Significantly more elderly had necrotic pulp (P < .001) and needed root canal treatment on teeth with full-coverage crown/bridge abutment (P < .001). It was significantly difficult to perform access cavity preparation and localize root canals on the elderly and on teeth with a full-coverage crown/bridge abutment. In regression analysis, the elderly presented with difficulties only during canal localization (P < .05). Second mesiobuccal canals were obturated in 43.5% of the young patients and 23.1% of the elderly patients. There were no significant differences in the number of treatment visits or the technical quality of root filling between the 2 groups. There were no significant differences in pain sensation, esthetics, masticatory function, or regular dental visits between the 2 groups. Elderly patients reported a significantly better OHRQOL (P < .05). Patients experiencing pain, patients needing treatment on anteriors/premolars, and females reported a significantly poorer OHRQOL (P < .05). Conclusions The elderly presented with treatment difficulty during canal localization and had better OHRQOL compared with young patients

Acute dental pain I : pulpal and dentinal pain

Den specialiserede anatomi i pulpa-dentin-organet samt den rige pulpale innervation fra trigeminusnerven forklarer de forskellige typer af smertefølelser i en tand. En kort skarp smerte er typisk for en A-(nerve) fibermedieret smerte, imens en langvarig, bankende smerte indikerer C-(nerve) fiberaktivitet. A-fibre reagerer på termiske eller mekaniske stimuli, såsom kolde drikke eller tandbørstning, imens C-fibre hovedsagelig aktiveres ved inflammatoriske mediatorer. Således vil en dvælende smerte indikere en irreversibel pulpal inflammation. Ved pulpitis vil der opstå strukturelle ændringer i de pulpale nerver, der samtidig frigiver neuropeptider, som udløser et immunrespons: neurogen inflammation. Smertefornemmelser under pulpitis kan variere fra hypersensibilitet overfor termiske stimuli til svære dunkende og uudholdelige smerter. Smerterne kan være meddelte og ofte vanskelige at lokalisere, hvorfor diagnostik af inflammation i pulpa er en klinisk udfordring. En biofilm forstærker hypersensitivitet af eksponerede dentinoverflader, fordi de mikrobielle irritamenter kan nå pulpa gennem åbne dentintubuli, hvorved der fremkaldes inflammation. Fjernelse af biofilm reducerer isninger i tænderne, men supplerende behandling er ofte nødvendigt med det formål at opnå en reduktion af dentinens permeabilitet. Cariesekskavering samt fyldningsterapi er en tilstrækkelig behandling ved en klinisk bedømt reversibel pulpitis, hvorimod endodontisk behandling er nødvendigt, når pulpitis har nået et irreversibelt stadium.The specialized anatomy of the pulp-dentin complex and the dense, predominantly noci- ceptive pulpal innervation from the trigeminal nerve explains the variety of pain sensations from this organ. Brief, sharp pain is typical of A-fibre-mediated pain, while long-lasting, dull/aching pain indi- cates C-fibre involvement. A-fibres react to cold or mechanical stimuli, such as cold drinks or toothbrushing, whereas C-fibres are mainly activated by inflammatory mediators. Thus, lin- gering pain suggests presence of irreversible pulpal inflammation. During pulpitis, structural changes of the pu pal nerves (sprouting) occur and neuropeptide release triggers an immune response; neurogenic inflammation. Pain sensations during pul- pitis can range from hypersensitivity to thermal stimuli to severe throbbing. There might also be aching pain, possibly referred and often difficult to localize. Thus, diagnosis is challenging for the clinician. Surface biofilm amplifies hypersensitivity of exposed dentin surfaces because irritants reach the pulp through open dentin tubules, producing inflammation. Removing the biofilm reduces dentin hypersensitivity, but supplemental treatment, aiming to reduce dentin permeability, is often necessary. Caries removal and filling therapy are adequate measures during reversible pulpitis if the pulp has maintained its ability to distance itself from the bacterial assault by producing reparative dentin. However, endodontic therapy is necessary when pulpitis has reached an irreversible stage