Managing older adults requiring endodontic treatment. A New Zealand practice-based research network study

Abstract

New Zealand (NZ) has an ageing population and like most countries, this is expected to increase. Many older adults (65+ years), including those with comorbidities, are retaining their teeth into old age, meaning treatment planning and management of these patients is often complex. The scope of endodontics encompasses the prevention or treatment of apical periodontitis and enables preservation of the natural dentition. There is a limited understanding of the preparedness of the NZ general dental workforce to manage the endodontic needs of older adults. The last national survey of endodontics among NZ dentists was reported over 17 years ago and it indicated that general dental practitioners (GDPs) provided endodontic treatment but technology, management philosophies and health in older adults has changed over time. Further, there is no recent information about NZ practice to guide clinical decision making. This Practice-Based Research Network study used a mixed-methods approach to better understand the endodontic needs of older adults and the challenges faced by GDPs in NZ. An online national survey was followed by focus group interviews with dentists who had varying experience levels and resided in main centres and regional areas of NZ. The specific objectives included investigating GDP philosophies, knowledge, practices, attitudes (including ageism) when managing older adults requiring endodontic treatment. Alongside this, the role of GDPs in providing domiciliary care and Continuing Professional Development (CPD) activities were also investigated. The survey collected quantitative and qualitative data from 382 GDPs (response rate 23.3%). Findings were analysed using SPSS and NVivo software. The emerging themes from the survey guided the face-to-face focus group interviews which provided deeper understanding and context to the survey responses. The results from the survey and focus groups showed that GDPs enjoyed treating older patients, however patients with a reduced cognitive ability rendered dental management ‘more complex’, ‘requiring more skill and patience’. Many GDPs expressed that the dental needs of older adults in residential care is significant, however the ability to provide care is limited. The endodontic requirements of older adults varied, with most patients wanting to retain their teeth, however ‘self-ageism’ was a barrier in many instances. Cost of root canal treatment (RCT) was a significant barrier for many patients with some clinicians electing to carry out vital pulp therapy as an interim means of managing their problem. Most GDPs performed RCT and teeth identified as difficult preoperatively (e.g. calcified canals, retreatment or especially strategically important teeth) were referred to specialist endodontists for management. The outcomes from this study can be translated to clinical practice, with a desire by most GDPs to undertake further CPD related specifically to the management of older adults with medical problems, and patient centred treatment planning.