The influence of educational information on understanding and perceptions of root canal treatment

Abstract

Patients frequently have a negative perception of root canal treatment (RCT) often due to a lack of understanding and knowledge of what the treatment involves. This may lead to patients being more anxious and fearful of their RCT. This can result in discomfort, dissatisfaction, and an increased rate of appointment cancellation or failures, or restorable teeth being extracted. Information is lacking about how patient education affects patient understanding, experience and overall perception of RCT. Research in other fields of healthcare has shown the benefit of patient education in aiding the informed consent process and enabling patients to be more accepting of their treatment, increasing understanding of treatment and decreasing anxiety. If patients are more aware of what to expect during RCT, it is anticipated that treatment would be less intimidating, perceived more positively, enabling patients to feel more informed to provide consent and less anxious throughout their treatment.

This Practice Based Research study used a mixed-methods scientific approach and had three aims. The first aim was to develop and compare educational material on RCT in written and website form with existing written material. The second aim was to determine if delivering enhanced education to patients prior to treatment influences anxiety, understanding and perception of the procedure. The third aim was to gain an understanding of the current methods used by general dental practitioners (GDPs) to provide patient education and obtain informed consent prior to RCT and to seek their feedback on the enhanced educational material for RCT.

In New Zealand (NZ), dental practitioners have access to an information sheet on RCT, produced by the New Zealand Dental Association (NZDA). In this study, a more detailed educational pamphlet and website were developed. Participants who required RCT were recruited by their GDP in private practices throughout NZ. Participants received a standardised verbal description of the treatment sequence from their dentist and were randomly assigned to one of three educational information groups: 1) the NZDA pamphlet (n=23), 2) the new pamphlet (n=21), or 3) an electronic link to a website which contained the same information as the new pamphlet (n=17). Patients completed a questionnaire before and after treatment which collected data on themes, dental pain, knowledge of RCT, anxiety, educational material, understanding and perception of RCT. Data was analysed using descriptive statistics and thematic analysis. General dental practitioners were also interviewed to provide feedback on RCT education and to understand their process of obtaining informed consent. An insight into the perceptions and understanding of RCT of a group of patients in NZ was obtained. Prior to commencing RCT, 42.6% of participants reported feeling anxious about having the treatment. Over one third (39%) of the participants felt anxious prior to attending the dentist. Patients found the new pamphlet and website informative and easy to understand. Over half (59.6%) of the participants felt that they had increased knowledge about RCT after education and treatment. The presentation of educational material prior to treatment increases understanding and lowers their anxiety and improves perception of treatment and meant they could more confidently make an informed decision and feel more positive about RCT. General dental practitioners interviewed all placed great importance on having an in-depth shared discussion of treatment with their patients prior to commencing RCT and obtaining verbal consent. Written consent is not routinely gained by the GDPs. The GDPs preferred the enhanced educational material to the existing NZDA pamphlet as it was more clear and comprehensive. The outcomes from this study, can be translated to clinical practice. It is crucial that GDPs understand that anxiety is often felt by patients prior to RCT and patients do not always present with a knowledge of treatment. The provision of enhanced educational material facilitates the informed consent process and improves the patient experience.