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 Table of Contents  
Year : 2017  |  Volume : 9  |  Issue : 6  |  Page : 255-257

Public knowledge and perception regarding endodontic treatment in a Saudi population

1 Dental Intern, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
2 Department of Restorative Dentistry, Division of Endodontics, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia

Date of Web Publication20-Dec-2017

Correspondence Address:
Dr. Hadi M Alamri
Department of Restorative Dentistry, Division of Endodontics, Prince Sattam Bin Abdulaziz University, Al-Kharj
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jioh.jioh_226_17

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Aim: The intent of this study was to assess the public's awareness regarding the importance of preserving natural dentition by investigating whether they prefer endodontic treatment versus a single tooth implant and to assess their knowledge and perception regarding the root canal treatment procedure itself. Materials and Methods: An electronic survey was sent out to the public throughout widely used social networks in Saudi Arabia, surveys excluded from the study were those filled by participants under the age of 18 and participants who work in a dental-related profession. Statistical analysis was done to test for significance. Results: Over 1000 participants have filled the survey, overall, the majority preferred endodontic treatment over implant replacement, however, there seems to be a misconception regarding the endodontic procedure, mainly in terms of the amount of pain during treatment and the number of visits required to complete the treatment. Conclusion: Based on the results of the study, it can be speculated that most of the treatments done were performed by less experienced clinicians, indicating the necessity to further indicate the referring system followed by practices, and the quality of treatment provided to the public.

Keywords: Endodontics, pain, public awareness

How to cite this article:
Aldawsari M, Alamri HM. Public knowledge and perception regarding endodontic treatment in a Saudi population. J Int Oral Health 2017;9:255-7

How to cite this URL:
Aldawsari M, Alamri HM. Public knowledge and perception regarding endodontic treatment in a Saudi population. J Int Oral Health [serial online] 2017 [cited 2022 Jan 26];9:255-7. Available from:

  Introduction Top

Fear of dental treatment due to anticipated or previously experienced pain has been known to be an important factor causing patients to delay or avoid dental treatment.[1] Studies have also shown that these patients are more prone to dental decay, have more missing teeth, and less functioning teeth mainly due to poor oral health maintenance.[2]

As oral health-care negligence leads to progression of dental caries to reach the pulpal space, indicating root canal treatment (RCT), patients seem to have a major concern regarding RCTs in terms of the number of visits required to complete the treatment,[3] and the amount of pain anticipated during treatment.[4]

Moreover, there are other factors besides the pain and duration of treatment that may affect the decision making when it comes to treatment planning, these include the patient's socioeconomic status, patient's commitment to treatment, attitude and behavior, and the patient's own preference.[5]

This survey study was conducted to evaluate the public's knowledge and perception toward endodontic treatments, and to evaluate their preference when it comes to different treatment options when provided.

  Materials and Methods Top

An electronic survey was distributed to a random sample of the population in Saudi Arabia using widely used social networks. Excluded surveys were those filled by participants <18 years of age or who are part of the dental profession, all other surveys were included in the study. Based on a pilot study and considering the population number, the sample size was calculated with the confidence level set to 95%. The survey contained personal questions including the age, gender, and profession, following that, multiple-choice questions related to endodontics were provided. The collected data were tabulated and analyzed using methods of descriptive analysis using SPSS V.22 (SPSS INC., Chicago, IL, USA).

  Results Top

A total of 1033 responses were received in 1 month, after excluding all those who were in professions related to dentistry, the total number of participants was 997. Out of those, 550 participants were females (54.9%) and 447 were males (45.1%). A total of 675 participants (67.7%) had a history of RCT [Table 1].
Table 1: General information of the participants included in the study

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Participants were asked whether they think if antibiotics can resolve an endodontic infection without the need to visit the dentist, only 109 participants answered (10.9%) yes. When assessing their knowledge regarding dental pain, they were asked if they believe that any dental pain indicates that the tooth requires endodontic treatment or not, 148 (15.8%) agreed while the remaining did not. A total of 695 participants (69.7%) believed that teeth become weaker after an RCT [Table 2].
Table 2: General knowledge regarding endodontics

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When analyzing the responses of the participants who had a history of RCT, 353 (52.3%) believe that the RCT is more painful than a tooth extraction; only 141 (20.9%) mentioned that the RCT was done in a single visit, whereas the remaining 534 respondents (79.1%) had the RCT performed in more than one visit. When asked in the case an RCT is indicated, whether they prefer to have an RCT or extract the tooth and replace it with an implant, 550 (81.5) preferred saving the tooth compared to 125 (18.5%) chose extraction and implant replacement [Table 3].
Table 3: Responses of the sample with a history of root canal treatment

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A total of 322 participants did not experience a RCT, when assessing their responses, 236 (73.3%) think that RCTs are more painful than tooth extractions, only 89 (27.6%) thought that the RCT procedure is done in a single visit, and when asked whether they would try saving the tooth or replacing it with an implant, 231 (71.7%) preferred saving the tooth [Table 4].
Table 4: Responses of the sample with no history of root canal treatment

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  Discussion Top

While reviewing the professions of the studied sample, the surveys of participating dentists and those who worked in a dentistry related field were excluded from the study to make sure that the answers were either based on previous experiences or expectations based on what the public hears about RCTs. The total number of participants is considered a strength in the present study as the sample size required based on the sample size calculations is <40% of the total number included, however, a limitation would be the fact that we do not know the quality of the endodontic treatment being performed. This area may be further investigated in future studies by assessing the quality of treatment being provided to the public.

When investigating the public's awareness regarding the effectiveness of antibiotics in treating endodontic infections, only 10.9% believed that they are sufficient in treating the infection, this is a good indication that the majority of the studied sample understand the importance of endodontic treatment, as antibiotics should only be prescribed in specific cases where systemic signs of infection are present in the patient requires antibiotic prophylaxis for other medical reasons.[6] Regarding the importance of cuspal coverage of the endodontically treated teeth, 69.7% of the responses noted that endodontically treated teeth become weaker than vital teeth, this stresses on the importance of postendodontic restoration type, in a study comparing the longevity of endodontically treated teeth with or without crowns, those without crowns were lost 6 times more than those that were crowned.[7]

As per the public's knowledge regarding the RCT procedure, when asked whether the RCT is more painful than a tooth extraction, 52.3% of those with a history of RCT believed it was more painful, and 73.3% of those who did not have a previous RCT thought it was more painful, both percentages are considered high. It is believed that the high percentage reported from those without a history of RCT may be due to misconception probably from what they have heard from others, however, the high percentage reported from those with a history of RCT is alarming. RCT procedures, when performed by a trained endodontist or an experienced dentist should be painless, the practitioner has several modalities to provide adequate anesthesia to be able to perform the procedure with minimal amount of pain if any, these include a profound infiltration or nerve block depending on the tooth and making sure the tooth patient is properly anesthetized, especially in cases with vital teeth, to assess that, the use of cold test seems to be the most reliable method to test whether or not the tooth in question is anesthetized.[8] Other than infiltration and nerve blocks, the clinician can provide supplemental anesthesia using intrapulpal anesthesia,[9] interligamentary anesthesia,[10] or intraosseous anesthesia.[11] Considering the effectiveness of these techniques in providing successful anesthesia, the percentage of reported pain during endodontic treatments should be lower, which is the opposite of what was found in the current study, this suggests that most of the treatments are not performed by experienced clinicians or trained endodontists.

Another finding from the results that also suggests that the majority of the RCTs performed were done by less experienced clinicians is the fact that 79.1% of the cases were completed over two or more visits. The current evidence show that flare-ups are found less in teeth endodontically treated in one visit compared to those treated in multiple visits,[12] and that although there is no statistically significant difference in the healing rate between teeth treated endodontically in a single or multiple visits, the healing rate was slightly higher for those treated in a single visit compared to those treated in multiple visits.[13]

When participants were asked in case the tooth is restorable, whether they prefer to save the tooth or replace it with an implant, the majority of the responses (81.5% participants with a history of RCT and 71.7% with no history of RCT) preferred RCT over implant replacement, this finding shows that the public is aware of the importance of preserving natural teeth. In a retrospective cross-sectional study evaluating the outcomes of endodontic treatments versus single tooth implants, it was shown that the failure rate was similar for both treatment options, however, postoperative complications and the need for subsequent treatments were higher in the implant group.[14]

  Conclusion Top

From the findings of this survey study, it seems that the public is aware of the importance of preserving natural teeth, however, there seems to be a misconception regarding the procedure itself, it might be plausible to speculate that most of the endodontic treatments done were performed by less experienced practitioners, if that is the case, it seems that a better referring system might be necessary to ensure that a high-quality treatment is provided to the public, this aspect should be further investigated in future studies.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Armfield JM. What goes around comes around: Revisiting the hypothesized vicious cycle of dental fear and avoidance. Community Dent Oral Epidemiol 2013;41:279-87.  Back to cited text no. 1
Schuller AA, Willumsen T, Holst D. Are there differences in oral health and oral health behavior between individuals with high and low dental fear? Community Dent Oral Epidemiol 2003;31:116-21.  Back to cited text no. 2
Sisodia N, Yadav S, Nangia T, Singh P, Yadav M, Singh HP. Dental patients' knowledge and attitude towards endodontics – A survey. Pharm J Sci Biomed 2015;5:80-3.  Back to cited text no. 3
Khan S, Hamedy R, Lei Y, Ogawa RS, White SN. Anxiety related to nonsurgical root canal treatment: A systematic review. J Endod 2016;42:1726-36.  Back to cited text no. 4
Hajjaj FM, Salek MS, Basra MK, Finlay AY. Non-clinical influences on clinical decision-making: A major challenge to evidence-based practice. J R Soc Med 2010;103:178-87.  Back to cited text no. 5
Aminoshariae A, Kulild JC. Evidence-based recommendations for antibiotic usage to treat endodontic infections and pain: A systematic review of randomized controlled trials. J Am Dent Assoc 2016;147:186-91.  Back to cited text no. 6
Aquilino SA, Caplan DJ. Relationship between crown placement and the survival of endodontically treated teeth. J Prosthet Dent 2002;87:256-63.  Back to cited text no. 7
Click V, Drum M, Reader A, Nusstein J, Beck M. Evaluation of the gow-gates and vazirani-akinosi techniques in patients with symptomatic irreversible pulpitis: A prospective randomized study. J Endod 2015;41:16-21.  Back to cited text no. 8
VanGheluwe J, Walton R. Intrapulpal injection: Factors related to effectiveness. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;83:38-40.  Back to cited text no. 9
Childers M, Reader A, Nist R, Beck M, Meyers WJ. Anesthetic efficacy of the periodontal ligament injection after an inferior alveolar nerve block. J Endod 1996;22:317-20.  Back to cited text no. 10
Nusstein J, Kennedy S, Reader A, Beck M, Weaver J. Anesthetic efficacy of the supplemental X-tip intraosseous injection in patients with irreversible pulpitis. J Endod 2003;29:724-8.  Back to cited text no. 11
Eleazer PD, Eleazer KR. Flare-up rate in pulpally necrotic molars in one-visit versus two-visit endodontic treatment. J Endod 1998;24:614-6.  Back to cited text no. 12
Moreira MS, Anuar ASN, Tedesco TK, Dos Santos M, Morimoto S. Endodontic treatment in single and multiple visits: An overview of systematic reviews. J Endod 2017;43:864-70.  Back to cited text no. 13
Chércoles-Ruiz A, Sánchez-Torres A, Gay-Escoda C. Endodontics, endodontic retreatment, and apical surgery versus tooth extraction and implant placement: A systematic review. J Endod 2017;43:679-86.  Back to cited text no. 14


  [Table 1], [Table 2], [Table 3], [Table 4]

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