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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 8  |  Issue : 2  |  Page : 49-53

Patient satisfaction and assessment of reason for seeking root canal treatment in a cost-free hospital setup


1 Associate Professor, Father Muller Medical College, A B Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to be University), Mangaluru, Karnataka, India
2 Department of Conservative Dentistry and Endodontics, A B Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to be University), Mangaluru, Karnataka, India

Date of Submission19-Jul-2020
Date of Decision23-Jul-2020
Date of Acceptance01-Aug-2020
Date of Web Publication23-Sep-2020

Correspondence Address:
Aditya Shetty
Additional Professor, Department of A B Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to be University), Mangaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/dmr.dmr_38_20

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  Abstract 


Aims: Patient's awareness and knowledge of the treatment is highly essential in everyday dental practice as it significantly influences the treatment outcome. Hence, the objective of this study is to assess the patient's satisfaction with root canal treatment (RCT) under various aspects. Subjects and Methods: This cross-sectional study was conducted on 130 patients in a tertiary care setting using a questionnaire which included pain perceived during the treatment, duration of treatment, esthetics and chewing ability of treated tooth, pleasantness of treatment, and the overall satisfaction. The data were analyzed using SPSS version 22. Statistical Analysis Used: Scores were compared using Kruskal–Wallis test. Results: The level of significance was set at 0.05. Median scores did not show a statistical difference in criteria scores between the teeth (P > 0.05). Among 130 patients, 81 preferred to undergo treatment in our institution due to the superior quality of treatment provided. Seventeen patients felt that the treatment provided was compromised. Of these 17 patients, nine patients reasoned it toward low standards due to cost-free treatment and eight patients felt that it was due to negligence or incompetency of the clinician. Conclusions: Pleasantness and satisfaction from treatment are very high due to a decrease in pain post-RCT, and most of them did not feel that the treatment was compromised in terms of quality or clinicians' negligence or incompetency.

Keywords: Attitude, awareness, dental treatment, satisfaction


How to cite this article:
Hegde N, Shetty A, Bhat R. Patient satisfaction and assessment of reason for seeking root canal treatment in a cost-free hospital setup. Dent Med Res 2020;8:49-53

How to cite this URL:
Hegde N, Shetty A, Bhat R. Patient satisfaction and assessment of reason for seeking root canal treatment in a cost-free hospital setup. Dent Med Res [serial online] 2020 [cited 2020 Dec 2];8:49-53. Available from: https://www.dmrjournal.org/text.asp?2020/8/2/49/295868




  Introduction Top


Root canal treatment (RCT) success is not determined solely by the status of bone healing and resolution of the factors affecting prognosis, but by patient perception and experience of the treatment rendered. Patient's pretreatment expectations and posttreatment satisfaction are strongly affected by social, psychological, and behavioral dimensions associated with the treatment.[1]

The purpose of the study was to assess the patient's satisfaction with RCT under various aspects. Considering that our institution is funded by a charitable trust, another objective of the study was to assess the patient's opinion on the relationship of cost-free treatment and quality of treatment.


  Subjects and Methods Top


The study was conducted on 130 patients in a tertiary care setting in the Department of Conservative Dentistry and Endodontics. The study protocol was approved by the institutional ethical and review board before the commencement of the study; the content of the questionnaire was made by the panel of experts in the Department. A pilot study was conducted among 40 patients seeking treatment to check the operational efficiency and reliability, validity, and precision of the questionnaire and criteria of scoring. Few modifications were made in the final questionnaire based on the responses given by the participants. The inclusion criterion was patients undergoing RCT for vital teeth and within the age group of 18–50 years. The exclusion criteria were patients undergoing RCT for nonvital teeth and medically compromised patients. Informed consent was obtained from all the study participants.

Following endodontic treatment carried out by a postgraduate student, the satisfaction component was assessed using a simple self-administered questionnaire, which comprised essential aspects of patient-related outcomes. The patients had to score each criterion between 1 and 10, with 10 being the most favorable outcome in each category. These include pain perceived during the treatment, duration of treatment, aesthetics and chewing ability of treated tooth, pleasantness of treatment, and overall satisfaction. The difference in each of these categories was assessed between teeth to see if there were any changes in the criteria between sextants.

Another segment that was assessed was the patient's opinion on the relationship between cost-free treatment and quality of treatment. The reason for undergoing treatment in our institution and patient's opinion on the quality of treatment was assessed. The results of the study were subjected to statistical analysis. The Statistical software IBM SPSS statistics 20.0 (IBM Corporation, Armonk, NY, USA) was used for the analyses of the data and Microsoft word and Excel were used to generate graphs, tables etc.


  Results Top


The mean score for the pleasantness of RCT was the highest among the various criteria and the least being esthetics and chew ability of the treated teeth [Table 1].
Table 1: Evaluation of patient - related outcomes

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Scores of pain perception, duration, esthetics, chewing ability, pleasantness, and overall satisfaction between teeth were compared using Kruskal–Wallis test [Table 2] and [Table 3]. The level of significance was set at 0.05. Median scores did not show a statistical difference in criteria scores between the teeth (P > 0.05) [Table 3].
Table 2: Comparative evaluation of patient - related outcomes between sextants

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Table 3: Kruskal-Wallis test for inter-sextant comparison

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Eighty one of 130 patients (62.3%) preferred to undergo treatment in our institution due to the superior quality of treatment provided [Graph 1]. 17 of 130 patients (13.1%) felt that the treatment provided was compromised [Graph 2]. Of these 17 patients, nine patients (52.94%) reasoned it toward low standards due to cost free treatment, and eight patients (47.05%) felt that it was due to negligence or incompetency of the clinician [Graph 3].




  Discussion Top


It can be argued that patient-centered outcomes may be less objective than radiographic indices; the field of psychometry includes properties such as validity, reliability, and responsiveness. Patient-centered outcomes may or may not complement radiographic indices.[2] Patients may know very little about endodontic pathophysiology but are generally highly sensitized to treatment-related fear, anxiety, and pain.[3] Patient-centered outcome measures provide feasible and appropriate methods for assessing and addressing patients concerns.[4] The patient can tell us how RCT affects their physical, psychological, and social function, i.e., their quality of life.[5] They are also concerned about the treatment cost, and whether the fee paid for the treatment fulfills their functional and esthetic demands or expectations.

Toothache has a profound behavioral impact affecting mood, ability to perform normal activities, sleep, job, and social activity.[6] Pain is frequently experienced during RCT, but generally only at low levels of severity. Pain during treatment is correlated to the level of anxiety and is generally less than anticipated.[7],[8] Accurately informing patients about the pain associated with treatment reduces the fear of pain.[9]

Dental anxiety, fear, and phobia are known to profoundly influence patient's behavior and felt experiences. Fearful patients are more likely to experience and remember more pain. Reasons for anxiety include feelings of vulnerability, danger, lack of control, unpredictability, and expectation of pain. Higher levels of educational attainment are associated with reduced dental fear and with reduced avoidance of dental treatment.[3],[10]

There is no doubt that the treatment can increase patients' physiologic and psychological stress levels. Patients scheduled to undergo RCT experience “fair” to “very much” fear of pain, or 3–4 on a 5-point scale.[11] Pretreatment diagnoses such as irreversible pulpitis and acute apical periodontitis have been associated with increased intraoperative pain. Intra-operative pain prevalence tends to increase after 45 min of treatment, presumably as initial anesthesia wears off.[12]

Dentists must be vigilant, and supplemental anesthesia must often be provided. The influence of single versus multiple appointments on post-treatment pain has been widely studied, subjected to systematic reviews and meta-analysis. Although patients undergoing single-visit RCT reported a higher frequency of pain medication use, compelling evidence for a difference is lacking. Likewise, it appears that post-treatment pain does not differ between initial RCT and retreatment.[13],[14]

Instruments such as the Strindberg Criteria or Orstavik's Periapical Index have been widely used to measure treatment outcomes. These instruments are extremely helpful in studying prognostic indicators and in measuring the long and irregular pathway toward radiographic bony healing. Although it can be argued that patient-centered outcomes may be less objective than radiographic indices, the field of psychometry is well developed and includes such properties as validity, reliability, and responsiveness.[3]

Dugas et al. measured patient satisfaction using a 10-point semantic scale; general satisfaction ratings were high. The vast majority of patients reported satisfaction with their decision to have RCT rather than extraction. The cost was by far the single greatest cause of dissatisfaction with the treatment, but pain during and after the treatment and poor esthetics were also reported.[15] However, in this study, 17 of 130 patients (13.1%) felt that the treatment provided was compromised (Chart 2). Of these 17 patients, nine patients (52.94%) reasoned it toward low standards due to cost-free treatment, and eight patients (47.05%) felt that it was due to negligence or incompetency of the clinician (Chart 3).

Hamasha and Hatiwsh used the oral health impact profile questionnaire, as used by Dugas et al. with 17 questions, before and 2 weeks after RCT. They also studied satisfaction 2 weeks after treatment using the semantic differential scale, previously used by Dugas et al. Before treatment, physical pain had a high prevalence of impact; psychological discomfort had a moderate prevalence, and the other fields had a low prevalence of impact. They found a marked improvement in physical pain, psychological discomfort, physical disability, psychological disability, social disability, and substantial improvement in functional limitation and handicap after RCT. General satisfaction was extremely high, 8.6 on a 10-point scale. Patients ranked their satisfaction from highest to lowest as: intraoperative pain, pleasantness, general satisfaction, chewing ability, time involved, cost, and postoperative esthetics.[16] This was seen to be similar to the results found in our study. The mean score for the pleasantness of RCT was the highest among the various criteria and the least being esthetics and chewing ability of the treated teeth [Table 1].

This study has few strong points that enhance its internal validity because the data was collected in a short term so that memory would not bias the patients' perceptions about the procedure. The interventions were performed by a single dentist with experience in RCT. Moreover, the outcome variables were collected without the presence of the clinician to prevent the bias that the presence of the clinician might exert on the perceptions of the patients treated. The patients had been informed that our aim was to monitor the procedure such that they were encouraged to be honest about what they felt.

Cost is a significant barrier to receiving care for toothache and a very important factor in patients' treatment choices.[6] The initial cost may grab patients' attention, but that is only the beginning. The initial cost of tooth retention through RCT and restoration is considerably lower than tooth replacement using implants or fixed dental prostheses.[17],[18]

Although the results in this study were satisfactory, a possible limitation was that the study subjects were not diverse enough in terms of race and geographical location. This makes generalizing the data difficult.


  Conclusion Top


Pulpal disease affects the quality of life, with moderate severity, primarily through physical pain and psychological discomfort. Pleasantness and satisfaction from treatment are very high due to a decrease in pain post-RCT and thus, increased quality of life. Majority of the patients opted to undergo RCT in our charitable institution due to the superior quality of treatment provided, and most of them did not feel that the treatment was compromised in terms of quality or clinicians' negligence or incompetency.

Studies focusing on patients' perception after RCT are scarce and patient-centered outcomes assessed through such scales and questionnaires provide an insight into the fundamental psychophysiology of the patient before, during, or after undergoing RCT. Patient's satisfaction toward endodontic treatment is related to different factors, some of these factors related to the patient himself, like having the chronic disease and the other are related to the nature of endodontic procedure itself. Dentists must understand the larger psychosocial environment as well as the technicalities of diagnosis, treatment and follow-up, and thus help clinicians to provide a higher quality of oral healthcare with increased patient satisfaction.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Vaughn LM, Jacquez F, Baker RC. Cultural health attributions, beliefs, and practices: Effects on healthcare and medical education. Open Med Educ J 2009;2:64-74.  Back to cited text no. 1
    
2.
Edwards RR, Doleys DM, Lowery D, Fillingim RB. Pain tolerance as a predictor of outcome following multidisciplinary treatment for chronic pain: Differential effects as a function of sex. Pain 2003;106:419-26.  Back to cited text no. 2
    
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Hamedy R, Shakiba B, Fayazi S, Pak JG, White SN. Patient-centered endodontic outcomes: A narrative review. Iran Endod J 2013;8:197-204.  Back to cited text no. 3
    
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Fitzpatrick R, Davey C, Buxton MJ, Jones DR. Evaluating patient-based outcome measures for use in clinical trials. Health Technol Assess 1998;2:i-iv, 1-74.  Back to cited text no. 4
    
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Liu P, McGrath C, Cheung GS. Quality of life and psychological well-being among endodontic patients: A case-control study. Aust Dent J 2012;57:493-7.  Back to cited text no. 5
    
6.
Cohen LA, Harris SL, Bonito AJ, Manski RJ, Macek MD, Edwards RR, et al. Coping with toothache pain: A qualitative study of low-income persons and minorities. J Public Health Dent 2007;67:28-35.  Back to cited text no. 6
    
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Georgelin-Gurgel M, Diemer F, Nicolas E, Hennequin M. Surgical and nonsurgical endodontic treatment-induced stress. J Endod 2009;35:19-22.  Back to cited text no. 7
    
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Pak JG, White SN. Pain prevalence and severity before, during, and after root canal treatment: A systematic review. J Endod 2011;37:429-38.  Back to cited text no. 8
    
9.
van Wijk AJ, Hoogstraten J. Reducing fear of pain associated with endodontic therapy. Int Endod J 2006;39:384-8.  Back to cited text no. 9
    
10.
Klages U, Ulusoy O, Kianifard S, Wehrbein H. Dental trait anxiety and pain sensitivity as predictors of expected and experienced pain in stressful dental procedures. Eur J Oral Sci 2004;112:477-83.  Back to cited text no. 10
    
11.
Armfield JM, Pohjola V, Joukamaa M, Mattila AK, Suominen AL, Lahti SM. Exploring the associations between somatization and dental fear and dental visiting. Eur J Oral Sci 2011;119:288-93.  Back to cited text no. 11
    
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Segura-Egea JJ, Cisneros-Cabello R, Llamas-Carreras JM, Velasco-Ortega E. Pain associated with root canal treatment. Int Endod J 2009;42:614-20.  Back to cited text no. 12
    
13.
Figini L, Lodi G, Gorni F, Gagliani M. Single versus multiple visits for endodontic treatment of permanent teeth: A Cochrane systematic review. J Endod 2008;34:1041-7.  Back to cited text no. 13
    
14.
Sathorn C, Parashos P, Messer H. The prevalence of postoperative pain and flare-up in single- and multiple-visit endodontic treatment: A systematic review. Int Endod J 2008;41:91-9.  Back to cited text no. 14
    
15.
Dugas NN, Lawrence HP, Teplitsky P, Friedman S. Quality of life and satisfaction outcomes of endodontic treatment. J Endod 2002;28:819-27.  Back to cited text no. 15
    
16.
Hamasha AA, Hatiwsh A. Quality of life and satisfaction of patients after nonsurgical primary root canal treatment provided by undergraduate students, graduate students and endodontic specialists. Int Endod J 2013;46:1131-9.  Back to cited text no. 16
    
17.
Moiseiwitsch J, Caplan D. A cost-benefit comparison between single tooth implant and endodontics. J Endod 2001;27:235.  Back to cited text no. 17
    
18.
Moiseiwitsch J. Do dental implants toll the end of endodontics? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;93:633-4.  Back to cited text no. 18
    



 
 
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  [Table 1], [Table 2], [Table 3]



 

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