Challenges of root canal treatment in poor countries

CHALLENGES OF ROOT

CANAL TREATMENT IN POOR

COUNTRIES

Rukoma A,M.

©2013

Introduction

RCT is changing in terms of

Demand

diagnosis techniques

treatment techniques

Equipment, instruments and materials used

This necessitates a workforce which is well

equipped and able to cope with the current

situations- A global challenge

1. Demand

Is increasing as a result of:

Increased awareness

population expansion and aging

Combination of the two

more people with increased awareness, the demand

is even higher

2. Diagnostic techniques

X-ray is still the reliable means of diagnosis

and assessment of the endodontium

Can show

Pulp status

Canal morphology

Periodontal and periradicular status

Determine if RCT can be done or not

Conventional X-ray

Most commonly used in poor countries

The reliability is about 60%-overlapping hides

some details multiple pictures +associated cons.

Time consuming in developing-several minutes

Difficult to store for future references

Despite these, some clinics don’t even have them

3D Digital X-rays

Not new but uncommon in poor countries-

expensive vs. conventional

Very accurate -adjustments can be made all

along

Quick

Easy to store

Easy to share

The recommended

Far from reach especially in public clinics

3.Treatment techniques

Relatively unchanged, mostly conventional.

However, advocates for surgical or

combined are increasing.

Exploratory surgery to diagnose the problem

that cannot be diagnosed in any other way;

for example, when NS-RCT and retreatment

have failed and the reasons for failure have

not been established.

Other indications for S-RCT include:

Repair of perforations, root resection, end

filling, apical curettage and biopsy

These need a practitioner with adequate

knowledge of the root anatomy and

endodontium in general

Note: additional canals in molars currently is

almost normal

Single visit RCT

Another area which is being promoted

Inter-visit burden is eliminate from both

patient and practitioner

The success rate is similar to multiple visits

Single visit cont.

depending on the nature of the disease as well as:

availability of instruments and materials

availability of time

skill and experience of the operator

and accessibility of the treated tooth for

instrumentation

In poor countries it is still a story of the future

4. Equipments, instruments and

materials

Power demanding-electricity availability and

reliability

Not adequate and not reliable

Quantity and quality-national and health

facility level

Not enough and uncertain quality

Unfourable for RCT

Dental chair and accessories

Generally,

Not enough, rarely serviced and old fashion

RCT is a demanding procedure

needs a full functioning (obeying) Dental

Chair

X-ray

Not enough, rarely serviced and mainly

conventional-2D for 3D object -overlapping-

aꜜccuracy

Handpieces

Quality and quantity

Autoclave every after patient

Light cure machine

Composite era

BUT WHY?

Inadequate funding

Few technicians with or without adequate

knowledge

END RESULT

Failure to perform as expected

Instruments

Some are

Outdated

Overused

Not readily available

Not even known

What instruments are we using for?

Filing

Compaction of GP

Cutting GP

Instruments to removing GP from the canals

NiTi flexo type are recommended

Visual aids

The use of magnification and adequate

lighting assist in accurate location of the root

canals

Rarely used in poor countries

5. RCT irrigating and filling materials

Not a big challenge

Irrigants-

Naocl

Core filling material

GP, Resin based e.g. Resilon points

Sealers

resin based sealers eg. AH series, endorez and

diaket

Crown filling material

Poor obturation but adequate crown seal has

better prognosis than adequate obturation

but poor crown seal

Ideally all root canal treated teeth must have

artificial crown fixed

Situation on the ground- very rare

6.Work force

General practitioners

The number is still low Taught under poor conditions

No continued education

Endodontists

The number is very low even in rich

countries- mostly in Dental schools

WHY?

Funding

expensive to train a dentist

Endodontist even more

Motivation

Complete dental chair

19TH CENTURY DC

Handpieces with light source

Visual aids

Dental loop with light Dental surgical micr.

GP Devices

Easy Cut NiTi rotary flexo file

7. Conclusion

There is a lot of challenges in performing

RCT in poor countries

8. Recommendation

RCT should be included under 10 health care

procedures and be given priority it deserve

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