Crout Desire for Periodontal, endodontic tx.ppt

Desire for Desire for Periodontal/Endodontic Therapy Periodontal/Endodontic Therapy in an Appalachian Communityin an Appalachian Community

R.J. Crout*1R.J. Crout*1, D.W. MCNEIL1, G. , D.W. MCNEIL1, G. CASTO2, J. WALLACE2, R.J. CASTO2, J. WALLACE2, R.J.

WEYANT2, J.E. PERRY3, and A.M. WEYANT2, J.E. PERRY3, and A.M. DAVIS3, M.L. MARAZITA2,1 West DAVIS3, M.L. MARAZITA2,1 West

Virginia University School of Virginia University School of Dentistry, 2 University of Dentistry, 2 University of

Pittsburgh, PA, 3 West Virginia Pittsburgh, PA, 3 West Virginia University, Morgantown, WV, USA, University, Morgantown, WV, USA,

BACKGROUNDBACKGROUND

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

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

BACKGROUNDBACKGROUND

• Adults: Lack of money as Adults: Lack of money as overwhelming reason dental care is overwhelming reason dental care is not obtainednot obtained

• 31% of all adults loose teeth <35 31% of all adults loose teeth <35 years of ageyears of age

• > 1/3 have lost 6 or more teeth> 1/3 have lost 6 or more teeth

MMWR 48, No 10, (March 1999)MMWR 48, No 10, (March 1999)

Caries Caries “The Bad” “The Bad” Children’s Oral Health in WVChildren’s Oral Health in WV• DMF among 36,325 school aged DMF among 36,325 school aged

children was 59 % higher than national children was 59 % higher than national averageaverage– 66% of the students had decay by age 866% of the students had decay by age 8– 37.5% had untreated decay37.5% had untreated decay– 53% lacked dental sealants53% lacked dental sealants

Epidemiology Snapshop 3(1) (April 1999) Epidemiology Snapshop 3(1) (April 1999)

BACKGROUNDBACKGROUND

• 25% of WV children live in poverty25% of WV children live in poverty– 13% in extreme poverty13% in extreme poverty– 25% live in family headed by single 25% live in family headed by single

parentparent

Kids Count Date online (1999) Kids Count Date online (1999)

Caries:Caries: Primary Dentition Primary Dentition

Kavita Kohli, DDS

Caries:Caries: Primary Dentition Primary Dentition

Kavita Kohli, DDS

BACKGROUNDBACKGROUND

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

OBJECTIVEOBJECTIVE

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

METHODSMETHODS

• 236 adults in two rural counties in WV236 adults in two rural counties in WV• Demographic variables: age, gender, Demographic variables: age, gender,

SES, and educationSES, and education• Value placed on oral health (Dental Value placed on oral health (Dental

Neglect Scale)Neglect Scale)• Subjects presented with hypothetical Subjects presented with hypothetical

question on endodontic and question on endodontic and periodontic tx vs extractionperiodontic tx vs extraction

Definitely No

Definitely Yes

I keep up my home dental care

1 2 3 4 5

I receive the dental care I should

1 2 3 4 5

I need dental care, but I put it off*

1 2 3 4 5

I brush as well as I should 1 2 3 4 5

I control snacking between meals as well as I should

1 2 3 4 5

I consider my dental health to be important

1 2 3 4 5

MethodsMethodsDENTAL

NEGLECT

SCALE

METHODSMETHODS hypothetical questionhypothetical question

• If I had a gum infection (that is, an If I had a gum infection (that is, an infection AROUND the tooth) and a infection AROUND the tooth) and a dentist told me that the tooth could dentist told me that the tooth could be saved with gum (periodontal) be saved with gum (periodontal) treatment, I would have this done.treatment, I would have this done.

• 1 Yes1 Yes

• 2 No 2 No

METHODSMETHODS

• 3 If no, why not?3 If no, why not?– a.a. Fear – too painfulFear – too painful– b.b. Too expensiveToo expensive– c.c. Lack of insuranceLack of insurance– d.d. Too far to travel, no sourceToo far to travel, no source– e.e. Too busy, office hours not convenientToo busy, office hours not convenient– f.f. Other (Please specify) ________Other (Please specify) ________– g.g. Don’t knowDon’t know– h.h. No responseNo response

Surgeon: Dr. Lee Johns

Surgeon: Dr. Lee Johns

Surgeon: Dr. Lee Johns

METHODSMETHODS hypothetical questionhypothetical question

• If I had a root canal infection (that is, If I had a root canal infection (that is, an infection INSIDE the tooth) and a an infection INSIDE the tooth) and a dentist told me that the tooth could dentist told me that the tooth could be saved with root canal be saved with root canal (endodontic) treatment, I would have (endodontic) treatment, I would have this done.this done.

• 1 Yes1 Yes

• 2 No 2 No

METHODSMETHODS hypothetical questionhypothetical question

• 3 If no, why not?3 If no, why not?– a.a. Fear – too painfulFear – too painful– b.b. Too expensiveToo expensive– c.c. Lack of insuranceLack of insurance– d.d. Too far to travel, no sourceToo far to travel, no source– e.e. Too busy, office hours not convenientToo busy, office hours not convenient– f.f. Other (Please specify) ________Other (Please specify) ________– g.g. Don’t knowDon’t know– h.h. No responseNo response

Surgeon: Dr. Lee Johns

Pulpal lesions…..

Mandibular first molar with large periradicular lesion extending into furcation.

Surgeon: Dr. Lee Johns

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

recommended.

RESULTSRESULTS

1.1. The adults ranged in age from 18-The adults ranged in age from 18-74. The mean age was 34.2 (SD = 74. The mean age was 34.2 (SD = 9.6) and included 36% males and 9.6) and included 36% males and 63% females. 63% females.

2.2. 72 (32%) would chose extraction 72 (32%) would chose extraction rather than either endodontics or rather than either endodontics or periodontal treatment or both. periodontal treatment or both.

METHODSMETHODS hypothetical questionhypothetical question

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

or periodontal treatment or both. or periodontal treatment or both.

RESULTSRESULTS

4.4. Regression analysis revealed that age, Regression analysis revealed that age, education level, socioeconomic status, education level, socioeconomic status, income, and dental neglect significantly income, and dental neglect significantly predicted these choices, with increased predicted these choices, with increased age, greater education, higher income and age, greater education, higher income and SES, and greater valued placed on oral SES, and greater valued placed on oral health status associated with preference health status associated with preference for endodontic and periodontic therapy for endodontic and periodontic therapy (model (model R2R2 = .19, = .19, F F (5, 176) = 8.2, (5, 176) = 8.2, p p < .001). < .001).

CONCLUSIONSCONCLUSIONS

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

CONCLUSIONSCONCLUSIONS

2.2. Almost one-third of this sample Almost one-third of this sample would choose extraction over such would choose extraction over such procedures that may save the procedures that may save the natural dentition.natural dentition.

3.3. Educational interventions to reduce Educational interventions to reduce fear and enhance oral health values fear and enhance oral health values may be helpful in reducing may be helpful in reducing endentualism in this populationendentualism in this population

TREATMENT VS TREATMENT VS EXTRACTION EXTRACTION CONSIDERATIONS! CONSIDERATIONS!

TREATMENT VS TREATMENT VS EXTRACTION EXTRACTION CONSIDERATIONS! CONSIDERATIONS!

TREATMENT VS EXTRACTION TREATMENT VS EXTRACTION

CONSIDERATIONS! CONSIDERATIONS!

TREATMENT VS TREATMENT VS EXTRACTION EXTRACTION CONSIDERATIONS! CONSIDERATIONS!

QuestionsQuestions