Factors influencing patients' choice of treatment for a tooth with irreversibly damaged pulp

Abstract

Dental caries is a post eruptive pathologic process of bacterial origin involving the dissolution of dental  hard tissues with resultant cavity formation and it may progress to irreversible pulpitis and apical periodontitis. The options for managing involved teeth include pulp therapy and tooth extraction. Despite the high success rates recorded in endodontically treated teeth however, some patients still opt for extraction of such teeth rather than retain them. The aim of this study was to determine the factors that  influencethe patient's decision to extract or retain their teeth as well as to determine what influenced the dentist's decision to extract or retain these teeth. This cross-sectional study was conducted at the Lagos  University Teaching Hospital, Surulere, Lagos State University Teaching Hospital, Ikeja, Federal Medical Centre, Ebute Metta and Randle General Hospital, Surulere, Lagos state. The subjects for the  study were recruited from patients attending the oral diagnosis clinic of each of the hospitals after a diagnosis of irreversible pulpitis or acute apical periodontitis was made. A structured interviewer  administered questionnaire was used for data collection. Less than half (43.8%) of the sample were males. About 66% of participants had a tertiary level of education while only 27.69% of them were in a  highly skilled occupation.Most of the respondents opted for extraction (75.4%) rather than root canal treatment (RCT) and the main reason for treatment choice was the instruction given by the Dentist. Over 26% of the participants  stated that the attending Dentist did not inform them about the treatment option of RCT. Male  respondents, patients with tertiary education and those  with health insurance were more likely to opt for root canal treatment even though the association was not significant. The condition of the tooth at diagnosis was the only significant factor that influenced the choice of treatment selected by the dentist. (p=0.000) Adequate education of the populace on the procedure and prognosis of root canal is required to reverse this trend. Patients should be actively involved in their treatment planning process.

Key Words: Dental Caries; Root Canal Treatment; Tooth Extraction.