Apical periodontitis (AP) is a prevalent disease that represents a host response to the infection of the root canal systems of the affected teeth. The tooth with AP can be treated with root canal treatment (RCT) with the intent of retaining the affected tooth, or be extracted. If the infected tooth is extracted, the space can be left edentulous or subsequently restored with a removable or fixed bridge, or an implant-supported crown (ISC).
Dentists’ preferences notwithstanding, the important ethical principle of patient autonomy suggests that patients’ values should play a substantial role in clinical decisions. It appears that information on patients’ thought processes and preferences for the management of teeth with AP is lacking. Thus, Azarpazhooh et al from the University of Toronto, Ontario, explored patient preferences for management of a tooth affected by AP, when considering its retention via RCT vs its extraction.
The study used a cross-sectional mail-out survey. The sampling frame randomly selected 800 patients who had previously been treated in the graduate endodontics, periodontics or prosthodontics clinics (n = 200/ clinic), or who were scheduled to receive RCT or ISC (n = 200). This was complemented by a convenience sample of patients in 10 community practices in Toronto (n = 200). Participants were asked to select their general preference for anterior and posterior teeth with AP between saving the tooth or extraction, and their specific preference for tooth retention via RCT or extraction.
Responses to the 4 preference questions are summarized in Table 2. Participants’ specific preference for tooth retention via RCT was slightly but significantly lower than their general preference (anterior tooth, 93.7% vs 97.2%; posterior tooth, 83.8% vs 89.6%; p < .005). Higher annual income, previous RCT, functional dentition, good/excellent self-rated oral health and regular dental visits were associated with higher preferences for tooth retention in response to different questions.
Within the limitations of this survey study, the responses of participants reflected a higher value for retention of an anterior than a posterior tooth affected by AP. One enabling factor (higher annual income), several need factors (previous RCT, functional dentition and good/excellent self-rated oral health) and one dental health behavior factor (regular dental visits) were associated with higher preferences for tooth retention in response to different questions, but none of the predisposing factors appeared to have such impact. When RCT and extraction are viable options, patients should be advised about the treatment options in an impartial manner and encouraged to communicate their individual preferences.