Improved Quality of Life Related to Endodontic TreatmentABSTRACT
Objective: To analyze the impact on quality of life related to endodontic treatment by applying the OHIP-14 questionnaire before and after completion of treatment.
Material and Methods: This is a longitudinal, prospective, non-controlled "before and after" intervention study that analyzed an initial sample of 312 participants and a final sample of 148 participants. Two questionnaires were used for data collection, one to define the sociodemographic profile of the participants and the Oral Health Impact Profile (OHIP-14) to measure quality of life. The impact at the second stage of the study was compared with that at the first using the nonparametric Wilcoxon test.
Results: The impact on quality of life before endodontic treatment was declared by 130 people (87.8%), and the most reported domains were psychological discomfort (75.7%), physical pain (66.9%), and psychological disability (52%). However, after endodontic treatment, only 10 people (6.8%) reported an impact, with the same dimensions being the most prevalent. Comparing impact frequencies, we observed improvements in the indices for all domains of the OHIP-14 instrument and in the overall score.
Conclusion: There was a significant reduction in the impact across all OHIP-14 domains analyzed, with a 92.3% reduction in overall impact before and after endodontic treatment, thus confirming the ability of endodontic treatment to improve quality of life.
Keywords:
Oral Health; Quality of Life; Root Canal Therapy.
Introduction
Consolidated as an effective and conservative therapeutic alternative, endodontic therapy refers to the diagnosis, prevention, and treatment of diseases and lesions of the pulp and associated periradicular conditions [1]. The areas of endodontic intervention are vast and include vital pulp therapy, regenerative endodontic procedures, conventional endodontic treatment, endodontic retreatment, and paraendodontic surgery. Its main objective is to preserve the natural functional dentition without causing discomfort to patients and to promote a better quality of life [2,3].
Quality of life can be defined as an individual's perception of their place in the society in which they live, as well as their goals, perspectives, values, and concerns [4]. In the context of collective health and public policies for the sector, information on quality of life has been included both as indicators for assessing the effectiveness, efficiency, and impact of certain treatments, and in comparing procedures for controlling health problems [5]. In this sense, the use of sociodental indicators, based on the patient's self-perception, offers important advantages for assessing the impact of oral conditions on well-being [6], the results of clinical treatments [7], and the planning and provision of dental services [8].
Among the existing socio-dental indicators, one of the most widely used today to assess oral health-related quality of life is the Oral Health Impact Profile (OHIP) 14, formulated in Australia in 1994 by Slade and Spencer [6]. The OHIP-14 was validated in Portuguese by Oliveira and Nadanovsky [9] in 2005. This instrument measures quality of life through 7 dimensions: functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap [6]. OHIP has been used in studies to assess various oral health conditions and problems that negatively impact quality of life. Recently, it has also been used in endodontics [10].
Studies have shown that endodontic treatment has a positive impact on individuals' quality of life, especially in the areas of physical pain, psychological discomfort, and psychological disability. However, studies on the relationship between endodontic treatment and quality of life among Brazilian adults remain scarce. Considering the need for universal access to endodontic therapy to improve quality of life, more studies are needed, especially in Brazil. This study aimed to analyze the impact of endodontic treatment on patients' quality of life at the endodontic clinic of the Brazilian Dental Association Espírito Santo Section (BDA-ES), before and after treatment.
Material and Methods
This section was written according to the methodological guidelines established by the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) instrument.
Study Design, Setting, and Ethical Clearance
This is an analytical study with a prospective longitudinal design of a non-controlled “before and after” intervention, carried out with patients who sought dental treatment at the endodontics clinic of the Brazilian Dental Association Espírito Santo Section (BDA-ES). The BDA-ES is a private postgraduate institution located in the municipality of Serra, Espírito Santo, Brazil, where postgraduate students provide dental care in various specialties.
This study was approved by the Human Research Ethics Committee of the Health Sciences Center of the Federal University of Espírito Santo, under opinion no. 4454344.
Participants
The study population consisted of patients aged 18 or older who sought dental treatment at the BDA-ES endodontics clinic. Individuals with cognitive impairments that prevented them from understanding the questionnaire questions were excluded.
Variables
The study's dependent variable was the impact on quality of life before and after endodontic treatment, measured using the OHIP-14 instrument. The independent variables analyzed were: gender, age, race/color, marital status, municipality of residence, schooling, socioeconomic status, and type of access to oral health services in the 12 months before the survey, using a structured questionnaire.
Data Sources
Data was collected in two stages. Firstly, before the endodontic treatment was carried out, in person, at the endodontic clinic of the Brazilian Dental Association Espírito Santo Section (BDA-ES), and secondly, one month after the treatment had been completed, through telephone contact with the participants. The one-month follow-up interval was chosen because post-operative pain after endodontic treatment is common, as the inflammatory and infectious processes cannot be eliminated immediately [11], and pain can persist for up to a week after treatment [12].
Initially, 312 participants were interviewed between January 19 and December 2, 2021. A structured script was used to collect sociodemographic information. The socioeconomic status of the participants was categorized according to the ownership of consumer goods and the education level of the head of household into A, B, C, D/E, using the Brazil Economic Classification Criterion version 2019 [13]. The OHIP-14 questionnaire assessed the participants' perception of the impact of the need for endodontic treatment on their quality of life. The questions were answered according to a Likert scale coded as: 0 = never, 1 = rarely, 2 = sometimes, 3 = often, and 4 = always. The higher the value assigned, the worse the self-perception of the impact [4]. In this study, we chose to use the method of expressing OHIP results as a categorical variable in two groups: with impact for the answers “always” and “often”, and without impact for “sometimes, rarely, and never”.
Of the 312 participants in the initial sample, 21 reported that they had not needed endodontic treatment, only restorative treatment, and 18 reported that they had had the tooth extracted due to complications that prevented the treatment from being completed, and were therefore excluded from the second stage of the study. At the second stage of the study, one month after treatment had been completed, the participants were contacted by telephone to fill in the OHIP-14 questionnaire again. Many participants reported that they had not completed their treatment during the research period (40.06%), or that it had not been possible to contact them by telephone. Therefore, the final sample consisted of those participants who had completed endodontic treatment and who answered the second OHIP-14 questionnaire.
Study Size
The sample calculation for the initial sample considered the approximate target population of 994 people who sought care at the BDA ES endodontics clinic during the study period. The prevalence of the impact of oral problems of 35%, supported by a previous study carried out in the state of Espírito Santo [14], a 95% confidence level, and a 5% margin of error were used as parameters for the sample calculation. A minimum sample of 260 participants was obtained. Considering a 20% loss rate, 52 participants were added, resulting in a final sample of 312 people. To calculate the study's final sample, a 95% confidence interval was used; the adopted proportion was 15% with a 5% margin of error, yielding a total of 148 participants.
Statistical Methods
The nonparametric Wilcoxon test was used to compare the frequency of impact at the second stage with that at the first stage. The IBM SPSS 20 statistical package was used for this analysis, and a significance level of 5% (p<0.05) was adopted.
Results
The demographic profile of the population analyzed in the final sample of this study was mostly female (59.5%), aged up to 43 (53%), brown (45.3%), married or living with a partner (54.1%), and living in the municipality of Serra (51.3%). Regarding socio-economic characterization, the majority reported studying for 13 years or more (83%), belonging to classes C/D/E (62.9%), and using private services to access oral health care in the last 12 months (54.1%).
The impact on quality of life before endodontic treatment was declared by 130 people (87.8%), and the domains with the greatest impact were psychological discomfort (75.7%), physical pain (66.9%), and psychological disability (52%) (Table 1).
The impact on quality of life after endodontic treatment was declared by only 10 people (6.8%), and the domains with the greatest impact were psychological discomfort (3.4%), physical pain (3.4%) and psychological disability (3.4%) (Table 2).
Using the nonparametric Wilcoxon test to compare impact on quality of life before and after endodontic treatment, an improvement was observed in all domains of the OHIP-14 instrument and in the overall score (Table 3).
Discussion
In this study, there was a significant improvement in OHIP-14 scores across all domains analyzed after endodontic treatment was completed. Compared with baseline, the total OHIP-14 score improved by 92.3% within 1 month. A similar result was also found by Carvalho and Duarte, who reported an impact reduction of 95% [15].
Other studies have also shown that endodontic treatment has had a positive impact on individuals' quality of life, especially in the areas of physical pain, psychological discomfort, and psychological disability [16-18]. In a prospective longitudinal study, OHIP-14 scores were compared before treatment, 1 month after treatment, and 6 months after treatment. It was found that all domains analyzed showed significant improvement in scores after treatment, with scores increasing by 40% in 1 month and 50% in 6 months [18]. In addition, a recent systematic review was conducted to determine oral health-related quality of life before and after endodontic treatment [19]. The initial search resulted in 415 articles, demonstrating the growing interest in the subject of endodontics and quality of life. The results confirm the evidence that there is a substantial improvement in quality of life after endodontic therapy.
The improvement in quality of life brought brought by endodontic treatment can be attributed to its high effectiveness in eliminating pain. Dental pain compromises daily activities, leading to fewer hours of sleep, lack of leisure activities, dietary restrictions, psychological disorders and loss of learning days at school and/or work [20,21].
This study found that a significant percentage of patients (40.06%) in the initial sample did not complete endodontic treatment during the study period. This finding can be explained by the fact that endodontic treatment may require more than one appointment, and patients often start treatment just to relieve pain and then don't return [22,23]. It should also be borne in mind that the study was conducted during the COVID-19 pandemic in Brazil, when dental care was suspended during periods of high contagion, which may have led patients to delay or abandon treatment.
The predominant sociodemographic profile of the participants who made up the final study sample remained the same as in the initial sample for all variables analyzed, except for "type of access to dental services in the last 12 months". In the initial sample, the majority of participants who sought endodontic treatment were UHS users or people who did not have access to health services (53.2%), while in the final sample, the majority of participants who completed treatment reported having access to private dental health services or health insurance (54.1%). Given that the population served by public services is the least socioeconomically advantaged [24,25], it can be assumed that participants with limited financial capacity faced the greatest difficulty in completing endodontic treatment.
Despite being available in DSCs throughout Brazil since the implementation of the National Oral Health Policy, evidence indicates a significant pent-up demand for endodontics in the UHS [26] and difficulty for patients to access treatment [27]. As a result, teeth that could be restored continue to be extracted due to limited procedural capacity in secondary care [28]. In addition, long queues and service delays contribute to a high rate of absenteeism and treatment abandonment among users [22,29].
Some limitations of the study should be noted. Given the cross-sectional design, the results obtained address hypotheses about associated factors, but lack the power to make causal inferences. Due to difficulties encountered in the final data collection, it was not possible to randomize the sample when contacting the participants who had completed the treatment by telephone, which may have led to selection bias. Contact via telephone may introduce response bias, as patients may find it difficult to accurately express their perceptions of quality of life without personal contact. The study was conducted at a private institution, which may limit the generalizability of its findings to broader populations or different clinical contexts.
Considering that the use of socio-dental indicators to evaluate oral health in relation to quality of life is of great value in estimating the effectiveness of public oral health programs, revealing the real needs of the population, it is important to highlight the need for more prospective longitudinal studies that can contribute to monitoring and evaluating the impact of endodontic treatment on quality of life to gain a better understanding of how endodontic therapy affects people's lives.
Conclusion
Before endodontic treatment, a high frequency of impact on quality of life was reported, reinforcing the damaging nature of the painful condition caused by pulp and periapical diseases on the well-being of individuals. One month after the end of treatment, there was a significant reduction in the impact across all OHIP-14 domains and in the overall impact, thus confirming the ability of endodontic treatment to improve quality of life.
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Financial Support
None.
Data Availability
The data used to support the findings of this study can be made available upon request to the corresponding author.
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Edited by
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Academic Editor:
Wilton Wilney Nascimento Padilha
