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Desire for PeriodontalEndodontic Therapy in an Appalachian Community

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Title: Desire for PeriodontalEndodontic Therapy in an Appalachian Community


1
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,

2
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
3
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)

4
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)

5
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)

6
Caries Primary Dentition
Kavita Kohli, DDS
7
Caries Primary Dentition
Kavita Kohli, DDS
8
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

9
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.

10
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

11
Methods
DENTAL NEGLECT SCALE
12
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

13
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

14
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15
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17
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

18
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

19
Pulpal lesions..
  • Mandibular first molar with large periradicular
    lesion extending into furcation.

20
Nine-month radiograph indicates a favorable
response to treatment. Further follow-up is
recommended.
21
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.

22
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.

23
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).

24
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.

25
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

26
TREATMENT VS EXTRACTION
CONSIDERATIONS!
27
TREATMENT VS EXTRACTION
CONSIDERATIONS!
28
TREATMENT VS EXTRACTION
CONSIDERATIONS!
29
TREATMENT VS EXTRACTION
CONSIDERATIONS!
30
Questions
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