Patients opting for immediate RCT treatment: A survey among private practitioners as well as Conservative and Endodontics postgraduates

Multiple factors can be responsible for a patient ignoring RCT-Root Canal Treatment, at the time of diagnosis. In this study, a Digital survey was done among dentists whether patients opt for immediate RCT or not, and outcome showed nearly equal response whereas 60.6% of patient's responses recorded that patient asked for medications and avoided opting for RCT, Thus, it can be concluded various criteria from patients perspective like dentist fees, fear of treatment or want to opt only from an endodontist for avoiding immediate Root Canal Treatment.


Introduction
Root canal treatment (RCT) is an essential element in the dental services provided to the population.The complete elimination of microorganisms from the root canal system is the goal of endodontic treatment 1.
If a certified dental practitioner advises RCT, there are patients who would like to take a second opinion or delay the treatment and ask for only medications.Multiple reasons can be cited like financial factors, Timing factors, and certain myths that lead them to avoid treatment.
Numerous studies investigated the attitude of dentists in Western countries such as Germany, the UK and the USA whereas very few studies have investigated the attitude of general dental practitioners toward various aspects of endodontic treatment in developing countries like India 2-4.
RCT is highly prevalent and patients advised RCT treatment ar considering this as a feared process.Various Studies have shown that fear and anxiety are the main determiants among patients advised RCT .These fears can be attributed to the ignorance of patients about root canal procedures.Patients often do not understand the nature of endodontic treatment and what it involves 5-8.
This study aims at the perception of patients regarding starting RCT if required and suggested by a certified dentist where a digital survey was done among general practitioners and post-graduates from the Department of Conservative and Endodontics.

Material and methods
A self-structured questionnaire was prepared which was sent to general practitioners as well as conservative and endodontics postgraduates where their responses would record patients opting or not opting for RCT in their practice was recorded.Informed consent was also obtained from all the participants which were included in the study.

Inclusion criteria
 Responses received only on digital platforms. Responses received from study participants within a given time limit and by certified dental practitioners only

Exclusion criteria
 Responses received after the given time limit and those dentists holding provisional BDS degree were excluded from the study. Responses received on the non-digital platform were excluded from the study o A total of 200 study participants were taken in this study based on convenience sampling technique along with inclusion and exclusion criteria o Questions were related to whether the patient opts only for medication or opts for RCT if advised by a dentist.Participants' responses showed that 45% of patients were opting immediate Root canal treatment when advised by dentist while 46.1% of patients were not opting the Root canal treatment even when advised by the dentist (Table 2).

Results
Table 3 depicted the participants response that majority of the patients i.e. 60.6% were preferring to have medication as the first line of treatment.While 28.3% were not opting for only medication as their first line of treatment.
As shown in Table 4, there was no statistically significant association between the participants and the responses in respect to patients opting immediate root canal treatment when advised (where p-value=0.17).Participants' responses depicted a significant association (p-value = 0.03) in terms of patients preferring only medicines for time being, where majority of the patients (n=109) were in favour of taking medications rather then going for treatment in their first visit.

Discussion
Patient's not opting for Root Canal Treatment even after caries involving pulp can be cited in multiple ways.The patient must be going for Root Canal Treatment at some other clinic/Hospital if not at the same dentist where it was been diagnosed.
Prices related to the RCT varies, depending upon area of practice, Further qualification of dentist as well as experience and all this factors can be debatable from patients perspective. 9tients often complain that they are too high and the treatment should be financed by NGO or insurance companies.
In present study nearly 46% of respondents were ready for RCT to prevent tooth loss According to the survey conducted by Daudet al 10 , 52% of the patients gained knowledge about the treatment through their relatives and friends.Subjects who were unaware of the specialized treatment reported the use of home remedies for relieving pain, which comprised the use of clove oil, balm application, self medications 8,11 , and this result was in accordance with the current study where nearly 45% of study participants denied to opt for immediate RCT without citing any reasons.
The proportion of patients who had not yet acquainted with the concept of endodontist was much higher. 12This can be due to the fact that patients were unaware of endodontics.Various studies revealed that the patient-dentist relationship strongly affects a patient's feeling to be safe and secure. 11,12Therefore, practitioners should explain the course of the treatment to patients, including alternative treatment plans.
In the present study results obtained for patients opting for only medicine were found to be statistically significant and above mentioned factors can also be one of the probable reasons.

Conclusion
Patients opting for immediate RCT and not opting for immediate RCT are nearly equal as per statistical data, Multiple factors can be put up but major ones can be the unavailability of an endodontist or a experience dentist, unawareness regarding consequences for the same and so dentist should be able to explain the demerits of not opting RCT while informing the diagnosis.

Disclosure of conflict of interest
No conflict of interest to be disclosed.

Figure 1 Figure 2
Figure 1 Participants' Response to Patient opting immediate RCT's if advised by a doctor

Table 1
Demographic details of the study population (n=180)

Table 2
Participants' Response to Patient opting immediate RCT's if advised by a doctor

Table 4
Comparison of Participants with the Responses obtained Test used: *Anova test (p-value significant at ≤ .05)Table1containsdescriptive summary data about the individuals participating in the study (N=180).The research investigation had somewhat more women (53.9%) than male (46.1%) participants, but there was no discernible difference in the gender distribution.Out of 180 Participants, 50.6% (n=91) were Endodontic postgraduates while 49.4% (n=89) were general private practitioners.