2020 Volume 8 Issue 4
Creative Commons License

Evaluation Of Knowledge Among Dental Patients Regarding Root Canal Symptoms And Treatment

Alwaleed K. Albadr1*, Mohammad K. Alqab1, Abdulmohsen AlRabiah2, Salman A. Alamoudi1, Mohammed Abu Hassna3, Abdullah A. Binmoamar1

1 Dental intern, Riyadh Elm University, Riyadh, Saudi Arabia. al-waleed999 @ hotmail.com

2Restorative Consultant, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

3 Restorative Specialist, Riyadh Elm University, Riyadh, Saudi Arabia.


ABSTRACT

To evaluate the awareness of dental patients of an ideal root canal treatment. This is a cross-sectional study conducted among dental patients using an online survey. 573 patients visiting the clinics of REU Muneseya campus were requested to fill the survey.

From these 573, nearly 188 were male respondents and 385 were female respondents. In further sectioning up the participants, most of them had belonged fro, the age group of 18 – 30 years which comprised of 45% in total, next was 21 – 45 years which was 36%, then we had 46 – 60 years which added up to 17%. The least contribution was from participants aging from 60+ years which made up 2% of the total respondents. A Chi-square test was done to compare the findings based on subgroups. Females showed a higher level of knowledge regarding the symptoms and appropriate management of root canal problems. Age was not associated with the knowledge of patients regarding root canal related issues and its treatment.

Key words: Root canal treatment, Symptoms, Knowledge, Dental patients, Evaluation


Introduction

One of the foreseeable managements to save an extensively decayed tooth is an endodontic treatment [1-4]. This involves the management of extensive carious lesions with removal followed by filling of root canal space. Since the discovery of the latest expertise and instruments in the dental field, it has made it more promising to take care of teeth that were of poor prognosis formerly such as root dilacerations or calcified canals [5, 6].

In Saudi Arabia, according to the Ministry of Health, the percentage of caries experience among the population is above 90%. This signifies that its population is highly vulnerable to go through endodontic treatment for the sake of saving a tooth. Many patients having root canal related issues are not aware of the symptoms associated with it, which results in the lack of treatment provided to these patients. Therefore, it is important to educate the public about signs and symptoms of root canal related problem to provide appropriate treatment to avoid unnecessary dental extraction [7, 8].

Although dental patients are more informed and seeking updates concerning their treatment, they are easily influenced by ambiguous information. This ambiguous information is consequential of fake advertisements and rumors, under-educated doctors, or non-specialized influencers. This information, with time, is considered as a standard that is sought by many patients [9, 10].

A low level of knowledge among the public was reported when conducted studies in several countries including India, Syria, and Saudi Arabia. This prevalence of low knowledge is associated with the non-treatment of deep caries leading to endodontics related problems. Several patients end up having dental extractions of teeth which could have been saved if there was the timely treatment provided [11-13].

Study hypotheses

Dental patients show a low level of knowledge regarding the symptoms related to root canal treatment.

Aims of the study

  • To evaluate the awareness of dental patients of an ideal root canal treatment.
  • To compare the findings based on age, gender, dental visits, and educational level.

Materials and Methods

Study Design

This is a cross-sectional study conducted among dental patients using an online survey.

Study Sample

573 patients visiting the clinics of a university dental hospital in Riyadh. were requested to fill the survey.

Study Instrument

An online questionnaire was designed using Google Forms with questions related to personal and demographic information followed by root canal symptoms and treatment-related questions.

Instrument Validity and Reliability

A pilot study was conducted by sending the survey to 20 participants and the data were inserted in SPSS version 22 to determine the reliability by using Chronbach’s coefficient alpha. The validity of the questionnaire was tested by sending it to experienced researchers in REU and no changes were made.

Statistical Analysis

Collected data were analyzed using SPSS version 22, where descriptive as well as inferential statistics were conducted. Comparisons between groups were made using the Chi-square test with the value of significance kept under 0.05.

Results and Discussion

In the following survey, there were nearly 573 respondents who were a part of this and had answered the questions asked. Of these 573, nearly 188 were male respondents and 385 were female respondents. In further sectioning up the participants, most of them had belonged fro, the age group of 18 – 30 years which comprised of 45% in total, next was 21 – 45 years which was 36%, then we had 46 – 60 years which added up to 17% and the least contribution was that from participants aging from 60+ of years which made up 2% of the total respondents (Table 1).

Following up was the educational segmenting, where the highest was 74% which belonged to the university, 22% were from high school, and the remaining 4% were from secondary and primary schools. Another major partitioning, which was vital to understand was that how many visits did these respondents had to the doctor to be able to answer the questions which were being asked. 57% of the people had nearly more than 7 visits, the rest of them had visited a lesser number of times comparatively (Table 1).

Comparisons were done on the basis of gender, age, educational levels and number of previous dental visits with their value of significance mentioned using Chi square test (Tables 2-5). The comparisons showed that their was statistically significant difference in the knowledge and perception of participants on the basis of gender, where majority of the p-values were less than 0.05. However, remaining comparisons including educational levels, age and number of dental visits did not revealed too many statistically significant differences as the p-values were greater than 0.05.

Chronbach’s Alpha value: 0.578

Table 1. Demographics of the study participants

Gender:

Male

Female

 

188 (33%)

385(67%)

Age:

18-30 Years

31-45 Years

46-60 Years

60+ years

 

258(45%)

207(36%)

95 (17%)

14 (2%)

Education:

Primary

Secondary

High School

University

 

7 (1%)

18 (3%)

123 (22%)

422 (74%)

Dental Visits:

1-3 Visits

4-6 Visits

7+ Visits

 

133 (23%)

112 (20%)

325 (57%)

 

 

 

 

Table 2. Comparison of the basis of Gender

Item

Male

Female

P-Value

Have you ever undergone root canal treatment?

Yes

58%

Yes

71%

0.003

Which kind of a pain in your point of view needs root canal treatment?

Constant pain from cold drink which needs painkillers

39%

Pain from a cold drink that doesn’t stay for a long time

22%

Pain from sugary foods and drinks

39%

Constant pain from cold drink which needs painkillers

38%

Pain from a cold drink that doesn’t stay for a long time

13%

Pain from sugary foods and drinks

49%

0.010

What would be your response to any symptom?

Use Home Remedies

24%

Visit a dentist

76%

Use Home Remedies

18%

Visit a dentist

82%

0.099

Can antibiotics alone resolve endodontic infections without visiting a dentist?

Yes

11%

No

71%

Don’t know

19%

Yes

5%

No

86%

Don’t know

9%

0.000

What is your level of knowledge regarding root canal treatment?

Know a lot

15%

Average knowledge

51%

Don’t know anything

34%

Know a lot

9%

Average knowledge

63%

Don’t know anything

28%

0.007

From your point of view, what is the correct treatment?

A

10%

B

40%

C

6%

Don’t know

44%

A

10%

B

38%

C

1%

Don’t know

51%

0.015

When you have finished your root canal treatment, have the doctor asked you to take a radiograph?

Yes

42%

Yes

35%

0.105

Table 3.  Comparison based on Age Groups

Item

18-30 Years

31-45 Years

46-60 Years

60+ Years

P-Value

Have you ever undergone root canal treatment?

Yes

48%

Yes

81%

Yes

84%

Yes

79%

0.000

Which kind of a pain in your point of view needs root canal treatment?

Constant pain from cold drink which needs painkillers

41%

Pain from a cold drink that doesn’t stay for a long time

15%

Pain from sugary foods and drinks

44%

Constant pain from cold drink which needs painkillers

37%

Pain from a cold drink that doesn’t stay for a long time

16%

Pain from sugary foods and drinks

47%

Constant pain from cold drink which needs painkillers

33%

Pain from a cold drink that doesn’t stay for a long time

19%

Pain from sugary foods and drinks

48%

Constant pain from cold drink which needs painkillers

50%

Pain from a cold drink that doesn’t stay for a long time

7%

Pain from sugary foods and drinks

43%

0.718

What would be your response to any symptom?

Use Home Remedies

21%

Visit a dentist

79%

Use Home Remedies

14%

Visit a dentist

86%

Use Home Remedies

26%

Visit a dentist

74%

Use Home Remedies

29%

Visit a dentist

71%

0.064

Can antibiotics alone resolve endodontic infections without visiting a dentist?

Yes

5%

No

80%

Don’t know

15%

Yes

6%

No

83%

Don’t know

11%

Yes

12%

No

79%

Don’t know

9%

Yes

0%

No

86%

Don’t know

14%

0.201

What is your level of knowledge regarding root canal treatment?

Know a lot

14%

Average knowledge

54%

Don’t know anything

32%

Know a lot

9%

Average knowledge

64%

Don’t know anything

27%

Know a lot

7%

Average knowledge

65%

Don’t know anything

27%

Know a lot

7%

Average knowledge

57%

Don’t know anything

36%

0.297

From your point of view, what is the correct treatment?

A

14%

B

40%

C

5%

Don’t know

41%

A

9%

B

39%

C

1%

Don’t know

51%

A

1%

B

37%

C

1%

Don’t know

61%

A

7%

B

29%

C

0%

Don’t know

64%

0.002

When you have finished your root canal treatment, have the doctor asked you to take a radiograph?

Yes

30%

Yes

44%

Yes

40%

Yes

29%

0.012

 

Table 4. Comparison based on Education Levels

Item

Primary

Secondary

High School

University

P-Value

Have you ever undergone root canal treatment?

Yes

86%

Yes

50%

Yes

61%

Yes

68%

0.133

Which kind of a pain in your point of view needs root canal treatment?

 

Constant pain from cold drink which needs painkillers

43%

Pain from a cold drink that doesn’t stay for a long time

29%

Pain from sugary foods and drinks

29%

Constant pain from cold drink which needs painkillers

39%

Pain from a cold drink that doesn’t stay for a long time

11%

Pain from sugary foods and drinks

50%

Constant pain from cold drink which needs painkillers

32%

Pain from a cold drink that doesn’t stay for a long time

13%

Pain from sugary foods and drinks

55%

Constant pain from cold drink which needs painkillers

40%

Pain from a cold drink that doesn’t stay for a long time

16%

Pain from sugary foods and drinks

44%

0.350

What would be your response to any symptom?

Use Home Remedies

29%

Visit a dentist

71%

Use Home Remedies

12%

Visit a dentist

88%

Use Home Remedies

26%

Visit a dentist

74%

Use Home Remedies

17%

Visit a dentist

83%

0.132

Can antibiotics alone resolve endodontic infections without visiting a dentist?

Yes

0%

No

86%

Don’t know

14%

Yes

17%

No

72%

Don’t know

11%

Yes

7%

No

76%

Don’t know

16%

Yes

6%

No

83%

Don’t know

11%

0.367

What is your level of knowledge regarding root canal treatment?

Know a lot

43%

Average knowledge

43%

Don’t know anything

14%

Know a lot

11%

Average knowledge

50%

Don’t know anything

39%

Know a lot

7%

Average knowledge

64%

Don’t know anything

29%

Know a lot

11%

Average knowledge

59%

Don’t know anything

29%

0.085

From your point of view, what is the correct treatment?

A

0%

B

43%

C

0%

Don’t know

57%

A

22%

B

28%

C

0%

Don’t know

50%

A

15%

B

34%

C

1%

Don’t know

50%

A

8%

B

41%

C

4%

Don’t know

47%

0.120

When you have finished your root canal treatment, have the doctor asked you to take a radiograph?

Yes

57%

Yes

44%

Yes

34%

Yes

37%

0.573

 

Table 5. Comparison of the basis of Dental Visits

Item

1-3 Visits

4-6 Visits

7+ Visits

P- Value

Have you ever undergone root canal treatment?

Yes

48%

Yes

63%

Yes

76%

0.000

Which kind of a pain in your point of view needs root canal treatment?

Constant pain from cold drink which needs painkillers

42%

Pain from a cold drink that doesn’t stay for a long time

16%

Pain from sugary foods and drinks

42%

Constant pain from cold drink which needs painkillers

37%

Pain from a cold drink that doesn’t stay for a long time

17%

Pain from sugary foods and drinks

46%

Constant pain from cold drink which needs painkillers

37%

Pain from a cold drink that doesn’t stay for a long time

16%

Pain from sugary foods and drinks

47%

0.832

What would be your response to any symptom?

Use Home Remedies

22%

Visit a dentist

78%

Use Home Remedies

29%

Visit a dentist

71%

Use Home Remedies

15%

Visit a dentist

85%

0.008

Can antibiotics alone resolve endodontic infections without visiting a dentist?

Yes

11%

No

74%

Don’t know

16%

Yes

8%

No

74%

Don’t know

18%

Yes

4%

No

87%

Don’t know

9%

0.002

What is your level of knowledge regarding root canal treatment?

Know a lot

14%

Average knowledge

53%

Don’t know anything

34%

Know a lot

8%

Average knowledge

59%

Don’t know anything

33%

Know a lot

11%

Average knowledge

63%

Don’t know anything

26%

0.209

From your point of view, what is the correct treatment?

A

16%

B

32%

C

2%

Don’t know

50%

A

9%

B

37%

C

4%

Don’t know

50%

A

8%

B

42%

C

3%

Don’t know

47%

0.177

When you have finished your root canal treatment, have the doctor asked you to take a radiograph?

Yes

36%

Yes

39%

Yes

37%

0.915

 

According to the research, oral health status can be indicated by basic cultural principles and executions impact the status of mouth and teeth, over care seeking attitude, use of home therapies, diet or behavior towards and determination of practice of health services. Therefore this is a survey where the overall results obtained in our study are in line with the research carried out by Albahiti et al whose objects to evaluate the attitude, awareness, and behavior of patients in a group of Saudi residents concerning root canals [14].

Another survey concluded that 41% of the participants had moderate information irrespective of curiosity for details and 27% of the participants knew a great deal regarding root canal management. Our results were quite unalike to the results presented by Alrahabi et al. [15]. The most common symptom that leads to the endodontic treatment in the majority of the patients was a toothache. A similar pattern was appreciated in previous researches. It is comprehended that skill and experience both go sideways and are immensely important for carrying out root canal treatment. The survey asked what factor was the priority of the patient while deciding what dental clinic they should go to; 68% chose the consultant, 1 percent chose doctor without specialty, and 4% dental students.

Different factors affect the dental anxiety of the patient which can be their age, education, gender, and socio-economic status but anxiety can be present independent of these factors. Dental fright leads to delayed dental visits or even skipping dental appointments. The study conducted by Doumani et al established that nearly 47% of patients affiliated root canal with severe pain caused by some stimulus such as sweets [16]. As compared to our study, the highest percentage that stood for the pain which was affiliated with sugary food was 44%.

Usually, the treatment time is long which bothers certain participants included in the study and the previous ones; other factors were discomfort and boredom that lead patients to ignore the treatments offered. Referred patients many at times ignore dental visits because of the high cost of dental procedures. In comparison to our study, which turned out to show that age had nothing to do with the kind of knowledge patients had, a research carried out by Emery et al also stated similar results where their percentage was that of 76% agreeable to the fact that age did not matter when speaking of symptoms related to root canal treatment [17].

The knowledge of patient plays an important role in what quality of oral health care is being offered to them. Therefore, patients should be taught about the importance of teeth related problems that decide their future oral health. According to the report by Hargreaves et al, the oral hygiene of a person is directly proportional to the attitude adopted by other household members [18]. This survey concluded that 73% of the females in the survey assumed better knowledge regarding root canals. These results are similar to the ones presented by our study which also concluded that usually females have had better knowledge regarding the root canal treatment.

The most preferred management plan offered by the general dentists up to 40% of the participants disagreed that antibiotics alone cannot resolve endodontic infections without visiting a dentist [19]. Whereas, in our results nearly 80% of the participants disagreed that antibiotics could not solve the serious issue of conducting a root canal and that it was something which had to be treated by the right procedure.

Another study conducted by Ahamed et al inquired about the knowledge and perception of the public towards the need and symptoms related to root canal treatment. They observed that 18.8% of people reported that they thought of needing root canal treatment when felt pain while eating [20]. Whereas, our study revealed that between 39% and 49% of participants felt the need for root canal treatment when experienced pain while eating.

Our results suggested that there is a low level of knowledge regarding root canal treatment as only 7% to 14% of the sample reported to ‘know a lot’. However, a study conducted in Kashmir reported otherwise, with 39% of the participants revealing that they know a lot about root canal treatment [21].

Conclusion

  • Females showed a higher level of knowledge regarding the symptoms and appropriate management of root canal problems.
  • Age was not associated with the knowledge of patients regarding root canal related issues and its treatment.
  • Education was also not associated with the patients’ knowledge.
  • Patients with a history of more number of dental visits had better knowledge and awareness of the symptoms related to root canal treatment as compared to less number of visits.
  • There is a need for dentists to educate their patients about timely visits to the dentist to diagnose and treat extensive carious lesions.

 

Acknowledgment: Authors of this study would like to acknowledge the support and cooperation of the research center of Riyadh Elm University.

Conflict of interest: None

Financial support: None

Ethics statement: This study fulfilled all the ethical requirements including data collection and confidentiality of study participants.

 

References

  1. Yamany IA. The Employment of CBCT in Assessing Bone Loss around Dental Implants in Patients Receiving Mandibular Implant Supported over dentures. Int J Pharm Res Allied Sci. 2019 Jul 1;8(3):9-16.
  2. Farsi NM, El Ashiry EA, Abdrabuh RE, Bastawi HA, El Meligy OA. Effect of Different Pulp Capping Materials on Proliferation and Odontogenic Differentiation of Human Dental Pulp Mesenchymal Stem Cells. Int J Pharm Res Allied Sci. 2018 Jan 1;7(3):209-23.
  3. Alamri AM, Alshammery HM, Almughamis MA, Alissa AS, Almadhi WH, Alsharif AM, et al. Dental Recession Aetiology, Classification and Management. Arch Pharm Pract. 2019 Apr 1;10(2):28-31.
  4. Asgari I, Soltani S, Sadeghi SM. Effects of Iron Products on Decay, Tooth Microhardness, and Dental Discoloration: A Systematic Review. Arch Pharm Pract. 2020 Jan 1;11(1):60-72.
  5. Pirani C, Friedman S, Gatto MR, Iacono F, Tinarelli V, Gandolfi MG, et al. Survival and periapical health after root canal treatment with carrierbased root fillings: fiveyear retrospective assessment. Int Endod J. 2018 Apr;51:e178-88.
  6. Alí A, Olivieri JG, Duran-Sindreu F, Abella F, Roig M, García-Font M. Influence of preoperative pain intensity on postoperative pain after root canal treatment: A prospective clinical study. J Dent. 2016 Feb 1;45:39-42.
  7. Bajawi AM, Mobarki YM, Alanazi FG, Almasrahi MY, Malhan SM, Alrashdi AF. Knowledge and awareness of root canal treatment among general public of Arar, Saudi Arabia. J Int Med Dent. 2018;5:56-62.
  8. Khan SQ, Khabeer A, Al Harbi F, Arrejaie AS, Moheet IA, Farooqi FA, et al. Frequency of root canal treatment among patients attending a teaching dental hospital in Dammam, Saudi Arabia. Saudi J Med Med Sci. 2017 May;5(2):145.
  9. Doumani M, Habib A, Qaid N, Abdulrab S. Patients’ awareness and knowledge of the root canal treatment in Saudi population: survey-based research. Pain. 2017;44(52):47.
  10. Janczarek M, Cieszko-Buka M, Bachanek T, Chałas R. Survey-based research on patients' knowledge about endodontic treatment. Pol J Public Health. 2014 Dec 10;124(3):134-7.
  11. Eswaran, R., Anbanandan, V. Dental patient’s knowledge, awareness, and attitude towards root canal treatment: A survey-based research. Int J Recent Sci Res. 2018;9(1):23214-8.
  12. Habib AA, Dormant MD. Al saysd T, Shams E. Heskul M, Abdulrab S, Bashnakli A, Alaskar A. Dental patient’s knowledge and awareness about root canal treatment in Syrian population: Survey-based research. IJRSR. 2017;8:20583-6.
  13. Aldawsari M, Alamri HM. Public knowledge and perception regarding endodontic treatment in a Saudi population. J Int Oral Health. 2017 Nov 1;9(6):255.
  14. Aziz Z, Abdullah M, Vello C, Thangavelu K. General dental practitioners' knowledge and practice on root canal treatment. Ann Dent, 2006;13(1):12-7.
  15. Albahiti, M. Knowledge and practices of decontamination during root canal treatment by dentists in Jeddah. Saudi Dent J. 2020;32(4):213-8.
  16. Alrahabi M, Ahmad MS. Knowledge regarding technical aspects of non-surgical root canal treatment in Al-Madinah Al-Munawarah private dental centers. Saudi Endod J. 2015 Sep 1;5(3):155.
  17. Doumani M, Habib A, Qaid N, Abdulrab S, Bashnakli A, Arrojue R. Patients’ awareness and knowledge of the root canal treatment in Saudi population: survey-based research. Int J Dent Res, 2017;5(2):89.
  18. Emery C. Endodontic treatment part 2: root canal preparation and obturation. Dent Nurs. 2015 Aug 2;11(8):445-7.
  19. Hargreaves K. Single-visit more effective than multiple-visit root canal treatment? Aust Dent J, 2006;51(2):200-1.
  20. Ahamed ZH, Alwakeel A, Alrshedan A, Altimsah F. Knowledge and awareness of root canal therapy for population in Saudi Arabia: A questionnaire-based study. Int J Med Sci Clin Invent. 2018;5:3560-4.
  21. Purra AR, Sajad M, Ahangar FA, Farooq R. Patient’s awareness and knowledge of the root canal treatment in Kashmiri population: A Survey-based Original Research. Int J Contemp Med Res. 2018;5(7):G12-5.
Issue 4 Volume 12 - 2024