Pre‐medical assessment of root–canal–filled teeth with asymptomatic apical periodontitis—A multifaceted balancing act

• Published in: International endodontic journal 2023-09, Vol.56 (9), p.1063-1076
• Main Authors: Olsson, Jenny, Wolf, Eva, Ljunggren, Anna
• Format: Article
• Language: English
• Subjects: Asymptomatic; Decision making; dentistry; Dentists; Expectancy; Gum disease; Interviews; Medical treatment; Periodontitis; qualitative research; Root canals; Teeth; uncertainty
• ISSN: 0143-2885; 1365-2591; 1365-2591
• DOI: 10.1111/iej.13941

Aim Prior to certain medical therapies, dental assessment and treatment of oral foci of infection are recommended. The aim of the present study was to acquire a deeper understanding of the decision‐making process regarding the pre‐medical management of root–canal–filled teeth with asymptomatic apical periodontitis (AAP). Methodology Hospital‐affiliated dentists in Sweden were contacted for a semi‐structured, in‐depth interview. The absolute inclusion criterion was that the dentists had experienced and could recount at least two authentic cases involving root–canal–filled teeth with AAP—one case having resulted in pre‐medical treatment, and one having resulted in expectancy. Fourteen interviews, with fourteen informants, were conducted and included in the study. During the interviews, open‐ended questions and comments encouraging the informants to elaborate and clarify their experiences were offered. The interviews were digitally recorded, transcribed verbatim and analysed using Qualitative Content Analysis with an inductive approach. Results A theme describing the latent content was identified through interpretation of the collected data: A multifaceted balancing act characterized by a sometimes‐difficult risk–benefit‐estimation, where an increased uncertainty entails an increased reliance on external opinions. Three main categories, comprising four sub‐categories, describing the manifest content were recognized: The tipping scale, The team effort and The frame of reference. Conclusions The current interview study found pre‐medical decision‐making regarding root–canal–filled teeth with AAP to be a multifactorial and contextual process marked by uncertainty and collaborative measures. Further research, resulting in the development of evidence‐based treatment guidelines, is suggested necessary.