An Analysis of Root Canal Treatments in Student Clinics of a Saudi University

INTRODUCTION

Information on reasons for a treatment in a community is necessary to understand the disease pattern. This information is also useful to determine cost effectiveness of the treatments. In terms of root canal treatment (RCT),several studies have been conducted in developed countries concerning reasons for root canal treatment1-3. Some studies are available from developing countries as well4-8. However, only two studies have been reported from Saudi Arabia, and these too were reported from King Saud University, Riyadh.4,6In recent years, many new dental institutions have been launched in Saudi Arabia. Prince Sattam Bin AbdulAziz University (PSAU), Alkharj is one of the new institutions; only three batches have graduated so far. It is necessary that studies be conducted in new institutions to understand the disease pattern in different areas of Saudi Arabia, as well as the demands for treatments. These studies will help in planning of health facilities in future.

According to the prescribed dental curricula of Saudi Arabia, endodontic training must be provided to all dental students within five years. A preclinical course is started in the third year requiring students to perform root canals on extracted teeth. Clinical courses follow, with fourth year dental students undertaking education in endodontic treatment tailored to specific requirements. In the fifth year, students are required to complete endodontic procedures as part of a comprehensive dentistry course. In the internship period, students undertake routine root canal therapy as part of their duty.

As there is no study available on reasons for root canal treatment at PSAU; the present study was undertaken. The objective of the study was to carry out an analysis of root canal treatments done in the students’ clinics of the 4th year dentistry course to understand the reasons of root canal treatment at PSAU.

METHODOLOGY

Information on root canal treatments (RCT) was obtained through a specially designed form. Information regarding patient age, gender, tooth number, and reasons of the RCT or those of failures was required. The criteria for reasons for RCT were those derived from Saad and Clem, 3 as shown in Table 1.

Table 1. The criteria used for reasons of root canal treatments.

The forms were distributed to the 4th year students of the PSAU attending during the academic year 2015-16. The participants were asked to register all root canal treatments carried out during a period of one academic year using their routine methods of diagnosis and treatment planning. The faculty was requested to examine the forms submitted by the students to verify the records. Data from the case records were collected and then coded for entry into a database using the Statistical Package for Social Sciences (SPSS), version 22. Frequencies were calculated using routine arithmetical methods.

RESULTS

Information was recorded on 202 RCTs. The majority (98%) of the patients were males while 2% were females. The average age of the patients was 36.9 years (±15.1).

The percentage distribution of reasons and the diagnosis of the pulpal conditions are given in Table 2 and 3 respectively. Irreversible pulpitis (59.9%) was the most common reason followed by necrosed pulp (22.8%). Exposure because of dental caries (67.3%) was the major reason for RCT. The other major reasons were intentional RCT for trauma (5.9 %) and overdentures (4%).

Table 2. Frequency distribution of pulpal diagnosis.

Table 3. Frequency Distribution of Reasons for RCT

As shown in Table 4, most (54.5%) of the RCTs were carried out in maxillary teeth. The most frequently treated teeth were maxillary Ist and IInd premolars (7.4% each).

In pre-operative radiographs (Table 5), 62.9% had normal periapical area, while 22.8% showed evidence of widening of periodontal ligament and were diagnosed as with chronic apical periodontitis. Only 1 case (0.5%) was reported with internal resorption.

Table 4. Distribution of root canal treatments in different sets of teeth.

In pre-operative radiographs (Table 5), 62.9% had normal periapical area, while 22.8% showed evidence of widening of periodontal ligament and were diagnosed as with chronic apical periodontitis. Only 1 case (0.5%) was reported with internal resorption.

Table 5. Pre-Operative Radiographs (Periapical Status).

DISCUSSION

The study has provided a useful information for root canal treatment pattern in the undergraduate clinical program at PSAU. It is hoped that more representative studies would be undertaken in Saudi Arabian the future, which will help in future planning for dental care.

In terms of the gender of the patients, the number of male patients exceeded the number of female patients. In some previous studies,1,3 the percentage of female patients was higher. PSAU campus caters for male dental students, and therefore is mainly meant for the male patients. Our results matched with a previous study in another Saudi University, where the number of male patients was also higher.6 It is also important to understand the social setup of Saudi Arabia, where female patients prefer to be treated by the female dentists.

Irreversible pulpitis and necrotic pulp were the most common causes for seeking root canal treatment by the patients. These results are in agreement with the previous studies conducted in Saudi Arabia and elsewhere.1,3,4,6-8. However in our study, compared to a previous study in Saudi Arabia,6 the necrotic pulp was outnumbered by irreversible pulpitis. It may be explained from the fact that the previous study was carried out at King Saud University, where there is a long waiting list. On the other hand, the patients at PSAU, it being a new campus with a lesser patient load, had an immediate access to endodontic clinics. Nevertheless, pulpitis and necrosis of pulp could be considered as is a natural sequelae of untreated dental caries. It is supported by the fact that 67.3% of the patients had carious exposure in this study. This fact is also evident from various epidemiological studies, which have shown that caries is a major dental problem in Saudi Arabia.9-11

Similar to the studies reported earlier,1-3, 6 trauma was a less likely cause for root canal treatments. In addition to the fact that the patients treated in this study were not treated as emergencies, the average age of the patients was 36.9 years, and it has been shown previously that trauma is less likely to occur in this age group.3

The frequency of intentional root canal for the purpose of over-dentures was only 4%. It is understandable as every effort is made to maintain healthy teeth, even in the provision of overdentures. Our results are similar to the previous studies. 3,6

Very few cases were reported for failure of root canal treatments; it was mainly because of short-obturations, when compared with over obturations. It may be argued that in overobturation, the canals are cleaned completely and that extruding material provides good apical seal and is well tolerated by periapical tissues.11Our sample of failed treatments was so small, so a generalized statement about RCT in Saudi Arabia could not be made. Further investigation is required in this regard.

One interesting feature of pre-operative radiographs worthnoting was absence of peripaical radiolucency in most cases despite carious exposure of the pulp. This presents a diagnostic dilemma. Therefore, the clinical and radiographic examinations may give conflicting results and definitive pulp and periapical diagnosis must be made with great care. Endodontic treatments are likely to take a significant share of the workload of dentistry in Saudi Arabia, in future.

Therefore, prevention and an early treatment of carious lesions is essential to reduce the need for root canal treatments.

CONCLUSIONS

1. Necrotic pulp and irreversible pulpitis were the predominant reasons for root canal treatment in this study.
2. Most of the cases for necrotic pulp and irreversible pulpitis occurred because of carious exposure.

DISCLOSURE

None declared.

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