Desire for PeriodontalEndodontic Therapy in an Appalachian Community

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Desire for Periodontal/Endodontic Therapy in an
Appalachian Community

• R.J. Crout1, D.W. MCNEIL1, G. CASTO2, J.
  WALLACE2, R.J. WEYANT2, J.E. PERRY3, and A.M.
  DAVIS3, M.L. MARAZITA2,1 West Virginia University
  School of Dentistry, 2 University of Pittsburgh,
  PA, 3 West Virginia University, Morgantown, WV,
  USA,

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BACKGROUND

• Highest rate in US of the loss of all natural
  teeth over age 65

National Governors Association Policy Academy on
improving oral health Access and outcomes for
children, 2001
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BACKGROUND

• Adults Lack of money as overwhelming reason
  dental care is not obtained
• 31 of all adults loose teeth lt35 years of age
• gt 1/3 have lost 6 or more teeth
• MMWR 48, No 10, (March
  1999)

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Caries The Bad Childrens Oral Health in WV

• DMF among 36,325 school aged children was 59
  higher than national average
• 66 of the students had decay by age 8
• 37.5 had untreated decay
• 53 lacked dental sealants
• Epidemiology Snapshop 3(1) (April 1999)

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BACKGROUND

• 25 of WV children live in poverty
• 13 in extreme poverty
• 25 live in family headed by single parent
• Kids Count Date online (1999)

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Caries Primary Dentition
Kavita Kohli, DDS
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Caries Primary Dentition
Kavita Kohli, DDS
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BACKGROUND

• Little research, however, has explored to what
  degree this Appalachian population would plan to
  utilize non-extraction treatments for dental
  infections that may originate from endodontic or
  periodontic etiologies. Non-extraction
  treatment options for these pathologies then
  include endodontic therapy and periodontal
  treatment

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OBJECTIVE

• The goal of this investigation was to explore to
  what degree this Appalachian population would
  utilize treatments that may help in the retention
  of teeth, and what factors may affect such
  choices. It was predicted that demographic
  variables and oral health values would affect the
  desire for endodontic and periodontal therapies
  as opposed to extraction.

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METHODS

• 236 adults in two rural counties in WV
• Demographic variables age, gender, SES, and
  education
• Value placed on oral health (Dental Neglect
  Scale)
• Subjects presented with hypothetical question on
  endodontic and periodontic tx vs extraction

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Methods
DENTAL NEGLECT SCALE
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METHODS hypothetical
question

• If I had a gum infection (that is, an infection
  AROUND the tooth) and a dentist told me that the
  tooth could be saved with gum (periodontal)
  treatment, I would have this done.
• 1 Yes
• 2 No

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METHODS

• 3 If no, why not?
• a. Fear too painful
• b. Too expensive
• c. Lack of insurance
• d. Too far to travel, no source
• e. Too busy, office hours not convenient
• f. Other (Please specify) ________
• g. Dont know
• h. No response

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METHODS hypothetical question

• If I had a root canal infection (that is, an
  infection INSIDE the tooth) and a dentist told me
  that the tooth could be saved with root canal
  (endodontic) treatment, I would have this done.
• 1 Yes
• 2 No

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METHODS hypothetical
question

• 3 If no, why not?
• a. Fear too painful
• b. Too expensive
• c. Lack of insurance
• d. Too far to travel, no source
• e. Too busy, office hours not convenient
• f. Other (Please specify) ________
• g. Dont know
• h. No response

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Pulpal lesions..

• Mandibular first molar with large periradicular
  lesion extending into furcation.

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Nine-month radiograph indicates a favorable
response to treatment. Further follow-up is
recommended.
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RESULTS

• The adults ranged in age from 18-74. The mean
  age was 34.2 (SD 9.6) and included 36 males
  and 63 females.
• 72 (32) would chose extraction rather than
  either endodontics or periodontal treatment or
  both.

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METHODS hypothetical
question

• 3. Reasons for preferring extraction over
  periodontal treatment included fear (16.7) and
  expense (43.3) similar reasons were reported
  for preferring extraction over endodontic
  therapy, although with different distributions
  (i.e., fear 33. 8 and expense 32.4).
• or periodontal treatment or both.

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RESULTS

• 4. Regression analysis revealed that age,
  education level, socioeconomic status, income,
  and dental neglect significantly predicted these
  choices, with increased age, greater education,
  higher income and SES, and greater valued placed
  on oral health status associated with preference
  for endodontic and periodontic therapy (model R2
  .19, F (5, 176) 8.2, p lt .001).

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CONCLUSIONS

• 1. Oral health values and demographic factors,
  including age, income, SES, and educational
  level, are significant factors which predicted
  choices for extraction versus endodontic or
  periodontat therapy in this Appalachian sample.

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CONCLUSIONS

• Almost one-third of this sample would choose
  extraction over such procedures that may save the
  natural dentition.
• Educational interventions to reduce fear and
  enhance oral health values may be helpful in
  reducing endentualism in this population

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TREATMENT VS EXTRACTION
CONSIDERATIONS!
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TREATMENT VS EXTRACTION
CONSIDERATIONS!
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TREATMENT VS EXTRACTION
CONSIDERATIONS!
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TREATMENT VS EXTRACTION
CONSIDERATIONS!
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Questions