- Received October 23, 2024
- Accepted November 26, 2024
- Publication December 10, 2024
- Visibility 4 Views
- Downloads 1 Downloads
- DOI 10.18231/j.idjsr.2024.036
-
CrossMark
- Citation
A retrospective study investigating prevalent diagnosis prompting endodontic treatment in a local North Indian population
Introduction
Endodontic treatment, commonly referred to as root canal treatment (RCT), is a highly specialized and technically challenging procedure within the field of restorative dentistry.[1], [2] The primary goals of root canal treatment are to eliminate intracanal infections and prevent reinfection by establishing conditions that promote the healing of apical periodontitis.[3] Through biomechanical cleaning, shaping, and disinfection, the root canal system can be prepared for three-dimensional obturation.[1], [4]
The Various risk factors, including dental caries, periodontal diseases, and trauma, can impact the dental pulp cause pulpitis.[1] Pulpitis is an inflammation of the pulpal tissue that may be acute or chronic, with or without symptoms, and reversible or irreversible.[5]
Irreversible pulpitis is diagnosed when it is evident that the dental pulp is unlikely to heal, despite any treatment efforts. The pulp tissue displays a range of acute and chronic inflammatory changes. To provide the patient with lasting relief at this stage, the remaining pulp must be removed, or the tooth must be extracted. A key characteristic of irreversible pulpitis is that the pain arises spontaneously and is not triggered by sudden temperature changes. This pain tends to persist for an extended period, typically lasting more than 20 minutes, and may intensify or be triggered when the patient reclines.[5]
When inflammation extends beyond the root canal system into the periodontal ligament space surrounding the root, the patient may experience pain during chewing, percussion, or palpation. This condition, with or without radiographic signs of periapical pathology, is known as symptomatic apical periodontitis (SAP). If the pulp does not react to pulp testing, it typically indicates irreversible pulp damage, leading to pulp necrosis. Without endodontic treatment, necrotic pulp may become infected, resulting in a localized acute apical abscess (LAAA), characterized by pus formation and localized swelling.[6], [7] If left untreated, the infection can spread to nearby fascial spaces or lymph nodes, potentially causing systemic symptoms such as fever, chills, malaise, or cellulitis.[6]
Ellis class 3 dental trauma refers to an injury that involves damage to the enamel, dentin, and pulp of the tooth. This type of trauma commonly affects the maxillary anterior teeth.[8] Prompt treatment is essential for an Ellis class 3 fracture because the exposed pulp can result in a loss of pulp vitality.[8], [9]
The main objective of dentistry is to help the public preserve healthy, natural dentition teeth. Endodontic treatment aims to preserve the functionality of teeth while safeguarding the patient's overall health.[10]
This study examines the relevance of endodontic treatment patterns in relation to diagnostic incidence, considering associations with age and gender.
Materials and Methods
A retrospective review was conducted of the hospital records of patients who visited the dental department and had root canal treatment done from January 2023 to January 2024. Demographic data such as Age, Gender, indication for treated tooth for root canals, and tooth treated were retrieved from the patient’s records. The data was collected by trained dentist using predesigned pro forma for each patient’s record.Medical records that lacked sufficient information were excluded. Ethical clearance for this study was obtained before the commencement of the study. All the collected data were tabulated into Microsoft excel. Data was analyzed using a computer software program, SPSS 20.
Results
A total of 2280 patient’s records were retrieved, out of which 35.1% were males and 64.9% were females ([Figure 1]). The age range of the patients was 10 and above 60 years while the mean age was 36.26 ([Table 1]). The commonest indication of RCT was Symptomatic irreversible pulpitis ([Table 2]). The association of gender and age was statistically significant with p value of 0.001 ([Table 4]). The highest incidence of RCT was found in the 31-40 years age group, followed by the 21-30 years age group ([Table 3] and [Table 5]).
|
Age |
10-20 |
155 |
6.8% |
|
21-30 |
572 |
25.1% |
|
|
31-40 |
823 |
36.1% |
|
|
41-50 |
548 |
24.0% |
|
|
51-60 |
136 |
6.0% |
|
|
>60 |
46 |
2.0% |
|
|
Total |
2280 |
100.0% |
|
|
Mean |
36.26 |
||
|
Standard Deviation |
10.53 |
|
|
Frequency |
Percent |
|
|
Diagnosis |
Asymptomatic apical periodontitis |
91 |
4.0% |
|
Asymptomatic irreversible pulpitis |
14 |
.6% |
|
|
Acute apical Abscess |
45 |
2.0% |
|
|
Condensing osteitis |
2 |
.1% |
|
|
Symptomatic apical periodontitis |
508 |
22.3% |
|
|
Symptomatic irreversible pulpitis |
1440 |
63.2% |
|
|
Chronic apical Abscess |
126 |
5.5% |
|
|
Ellis class 3 fracture |
54 |
2.4% |
|
|
Total |
2280 |
100.0% |
|
|
Sex |
Chi-Square |
p-value |
||||||
|
Male |
Female |
Total |
|||||||
|
Age |
10-20 |
81 |
10.1% |
74 |
5.0% |
155 |
6.8% |
58.455 |
.0001** |
|
21-30 |
203 |
25.4% |
369 |
24.9% |
572 |
25.1% |
|
|
|
|
31-40 |
258 |
32.3% |
565 |
38.2% |
823 |
36.1% |
|
|
|
|
41-50 |
164 |
20.5% |
384 |
25.9% |
548 |
24.0% |
|
|
|
|
51-60 |
64 |
8.0% |
72 |
4.9% |
136 |
6.0% |
|
|
|
|
>60 |
30 |
3.8% |
16 |
1.1% |
46 |
2.0% |
|
|
|
|
Total |
800 |
100.0% |
1480 |
100.0% |
2280 |
100.0% |
|
|
|
|
Sex |
Chi-Square |
p-value |
||||||
|
Male |
Female |
Total |
|||||||
|
Diagnosis |
Asymptomatic apical periodontitis |
25 |
3.1% |
66 |
4.5% |
91 |
4.0% |
22.391 |
.002** |
|
Asymptomatic irreversible pulpitis |
4 |
.5% |
10 |
.7% |
14 |
.6% |
|
|
|
|
Acute apical Abscess |
20 |
2.5% |
25 |
1.7% |
45 |
2.0% |
|
|
|
|
Condensing osteitis |
0 |
0.0% |
2 |
.1% |
2 |
.1% |
|
|
|
|
Symptomatic apical periodontitis |
173 |
21.6% |
335 |
22.6% |
508 |
22.3% |
|
|
|
|
Symptomatic irreversible pulpitis |
497 |
62.1% |
943 |
63.7% |
1440 |
63.2% |
|
|
|
|
Chronic apical Abscess |
48 |
6.0% |
78 |
5.3% |
126 |
5.5% |
|
|
|
|
Ellis class 3 fracture |
33 |
4.1% |
21 |
1.4% |
54 |
2.4% |
|
|
|
|
Total |
800 |
100.0% |
1480 |
100.0% |
2280 |
100.0% |
|
|
|
|
Age |
Chi-Square |
p-value |
|||||||
|
10-20 |
21-30 |
31-40 |
41-50 |
51-60 |
>60 |
Total |
||||
|
Diagnosis |
Asymptomatic apical periodontitis |
2 |
28 |
38 |
13 |
8 |
2 |
91 |
200.395 |
.0001** |
|
1.3% |
4.9% |
4.6% |
2.4% |
5.9% |
4.3% |
4.0% |
|
|
||
|
Asymptomatic irreversible pulpitis |
1 |
4 |
5 |
3 |
1 |
0 |
14 |
|
|
|
|
.6% |
.7% |
.6% |
.5% |
.7% |
0.0% |
.6% |
|
|
||
|
Acute apical Abscess |
3 |
8 |
21 |
13 |
0 |
0 |
45 |
|
|
|
|
1.9% |
1.4% |
2.6% |
2.4% |
0.0% |
0.0% |
2.0% |
|
|
||
|
Condensing osteitis |
0 |
0 |
0 |
0 |
2 |
0 |
2 |
|
|
|
|
0.0% |
0.0% |
0.0% |
0.0% |
1.5% |
0.0% |
.1% |
|
|
||
|
Symptomatic apical periodontitis |
33 |
132 |
189 |
117 |
22 |
15 |
508 |
|
|
|
|
21.3% |
23.1% |
23.0% |
21.4% |
16.2% |
32.6% |
22.3% |
|
|
||
|
Symptomatic irreversible pulpitis |
76 |
352 |
513 |
377 |
93 |
29 |
1440 |
|
|
|
|
49.0% |
61.5% |
62.3% |
68.8% |
68.4% |
63.0% |
63.2% |
|
|
||
|
Chronic apical Abscess |
17 |
28 |
50 |
21 |
10 |
0 |
126 |
|
|
|
|
11.0% |
4.9% |
6.1% |
3.8% |
7.4% |
0.0% |
5.5% |
|
|
||
|
Ellis class 3 fracture |
23 |
20 |
7 |
4 |
0 |
0 |
54 |
|
|
|
|
14.8% |
3.5% |
.9% |
.7% |
0.0% |
0.0% |
2.4% |
|
|
||
|
Total |
155 |
572 |
823 |
548 |
136 |
46 |
2280 |
|
|
|
|
100.0% |
100.0% |
100.0% |
100.0% |
100.0% |
100.0% |
100.0% |
|
|
Discussion
This research analyzed the endodontic procedures conducted in the dental department over a one-year period. It is a retrospective study focusing on the most prevalent endodontic diagnosis that drives patients for endodontic treatment.
In this study, the demand for endodontic treatment was higher among females (64.9%) compared to males (34.1%)The reason for this finding remains unclear and was not specifically evaluated in this study. A similar study conducted by AdenikaololadeAwotile found that 54.5% of females and 45.4% of males opted for endodontic treatment.[1] However, it aligns with the general belief that females tend to be more health-conscious, which may lead them to seek treatment earlier and have cavities treated before they progress to pulpal and periradicular diseases.
The largest proportion of patients receiving endodontic treatment during the study period was in the 31-40 age group (36.1%), followed by the 21-30 age group (25%), and then the 41-50 age group (24%). Another study by Osadolor OO showed the highest age group for endodontic treatment as 20-29 years (39.6%), with the 30-39 age group following at 26.9%.[11] This emphasizes that caries, a primary contributor to dental disease and its complications, is more commonly observed in younger age groups. As a result, prioritizing consistent and effective preventive measures for children and young adults is essential. [12]
Throughout this study period, there were 91 cases (4.0%) of Asymptomatic apical periodontitis, while 508 cases (22.3%) involved Symptomatic apical periodontitis. Another study by Idon Paul Khodare found 129 cases of acute apical periodontitis and 59 cases of chronic apical periodontitis.[13] A study by AU Umanah reported 76 cases (35.7%) of apical periodontitis.[12] Similarly, research conducted by Md. AsdaqHussain found 141 cases (68.4%) of symptomatic apical periodontitis, while asymptomatic apical periodontitis was observed in 22 cases (10.7%). [14]
In our survey, there were 14 cases of asymptomatic irreversible pulpitis, while symptomatic irreversible pulpitis was observed in 1,440 cases. In another study, Andrea Soledad Sepulueda Perez identified 34.58% cases of irreversible pulpitis.[15] The study done by Rosa Scavo also showed the most frequent diagnosis for endodontic treatment is irreversible pulpitis.[16] AU Umanah's study also reported 46.9% cases of irreversible pulpitis.This could be linked to late patient presentation, as many people tend to seek dental care only when they experience pain or the condition has reached an advanced stage. This emphasizes the critical need for strengthened oral health education and awareness initiatives. [17]
The present study shows 45 cases (2%) of acute periapical abscess, while 126 cases (5.5%) exhibit chronic periapical abscess. Similarly, a study by Md. AsdaqHussain reported 20 cases (9.7%) of chronic periapical abscess and 8 cases (3.9%) of acute periapical abscess. [14] Idon Paul Khodare's study found 13 cases of acute periapical abscess and 19 cases of chronic periapical abscess.[13] The study done Sotunde O.A shows 5.9% cases of periapical abscess.[18] Another study by Chris Noel shows 53.33% cases of periapical abscess. [19]
In our survey, 54 cases (2.4%) of Ellis class 3 fractures resulting from trauma were recorded during the survey period. A similar study by TaanyaImtiaz reported 65% cases of ellis class 3 fracture involving the dental pulp. Another study by Nivetha G documented 42.6% cases ofellis class3 fracture higher in the young age group,[20] while AU Umanah’s research identified 22 cases (10.4%) involving dental pulp trauma. [12]
Geographical restrictions and a smaller sample size are the study's limitations. Larger sample sizes and a more comprehensive geographic focus in future research can aid in improved diagnostic and treatment planning for endodontic procedures.
Conclusion
The most common indication of root canal treatment is symptomatic irreversible pulpitis. There is a need for dental awareness among patients so that carious lesions can be treated early and also educating patients will help in preventing dental caries.
Conflict of interest
None
Source of funding
None
References
- A Awotile, L Enone, O Temitope, O Adenuga-Taiwo. A retrospective study of endodontic treatment among patients in Southwest Nigeria. Edorium J Den 2022. [Google Scholar]
- NM Ismail, AR Ismail, WAR Wan Nor Syuhada. Root canal treatment in Hospital UniversitiSains Malaysia Dental Clinic - a 5-year retrospective study. Arch Orofac Sci 2008. [Google Scholar]
- MK Alrahabi. Root canal treatment in elderly patients: A review and clinical considerations. Saudi Med J 2019. [Google Scholar]
- H Schilder. Filling root canals in three dimensions. Dent Clin North Am 1967. [Google Scholar]
- J Philip Sapp, LR Eversole, GP Wysocki. Infections of Teeth and Bone. Contemporary Oral and Maxillofacial Pathology 2004. [Google Scholar]
- M P Tampi, L Pilcher, O Urquhart, E Kennedy, KK O’brien, PB Lockhart. Antibiotics for the urgent management of symptomatic irreversible pulpitis, symptomatic apical periodontitis, and localized acute apical abscess. J Am Dent Assoc 2019. [Google Scholar]
- DT Zero, AF Zandona, MM Vail, KJ Spolnik. Dental caries and pulpal disease. Dent Clin North Am 2010. [Google Scholar]
- T Imtiaz, HS Adimulapu, I Pandiyan, S Bhandari. Dentist perspective on knowledge and practice toward Ellis class 3 tooth fracture: A survey. J Adv Pharm Technol Res 2022. [Google Scholar]
- A Navabazam, SS Farahani. Prevalence of traumatic injuries to maxillary permanent teeth in 9- to 14-year-old school children in Yazd, Iran. Dent Traumatol 2010. [Google Scholar]
- . European Society of Endodontology, Quality guidelines for endodontic treatment: consensus report of the European Society of Endodontology. Int Endod J 2006. [Google Scholar]
- OO Osadolor, F Egbonwonu. Pattern of Demand for Endodontic Treatment In A Nigerian Teaching Hospital. Int J Dent Med Sci Res 2019. [Google Scholar]
- A Umanah, B Osagbemiro, A Arigbede. Pattern of demand for endodontic treatment by adult patients in port-harcourt, South-South Nigeria. J West AfrColl Surg 2012. [Google Scholar]
- PI Idon, Y Janada. Pattern of Endodontic Treatment among Nigerian Adults: A Single Centre Study. Pesq Bras Odontoped Clín Integr 2018. [Google Scholar]
- MA Asdaq, S Naz, HM Singh, A Singh, M Haque, H Shah. Reasons and Pattern of Demand for Root Canal Treatment Among Patients Attending A Tertiary Care Center of Madhesh Province: A Descriptive Cross-Sectional Study. Med Phoenix 2023. [Google Scholar]
- AS Pérez, EC Bolado, LA Camacho-Aparicio, LP &hervert. Prevalence of pulp and periapical diseases in the endodontic postgraduate program at the national autonomous University of Mexico. J Clin Exp Dent 2014. [Google Scholar]
- R Scavo, RM Lalis, O Zmener, S Dipietro, D Grana, CH Pameijer. Frequency and distribution of teeth requiring endodontic therapy in an Argentine population attending a specialty clinic in endodontics. Int Dent J 2011. [Google Scholar]
- CN Agholor, MA Sede. Endodontic treatment: an analysis of demand by adult patients in a tertiary hospital in southern Nigeria. Nig J Dent Res 2018. [Google Scholar]
- O Alalade, F Ikusika, YI Adeyemo. A 5 year audit of root canal treatment at a tertiary centre in northwest Nigeria. Nigeria J Restor Dent 2019. [Google Scholar]
- Chris Timothy, &ramani, Pratibha. Prevalence and Assessment of Periapical Lesions in Subjects Reporting to a Private Teaching Hospital. Indian J Forensic Med Toxicol 2020. [Google Scholar]
- K, Anjaneyulu. Prevalence of Ellis Class III in Patients Above 16 Years. Int J Dent Oral Sci 2021. [Google Scholar]