General dental practitioners’ experience of endodontic treatment, difficulties and barriers. A survey study.
Cajsa Jernström and Evelina Svanelind Tutor: Majid Ebrahimi
The number of words in the abstract: 244 The number of words in the text: 3919 The number of tables and figures: 3 The number of cited references: 24
ABSTRACT
Background: Substandard technical quality of root fillings is strongly correlated with apical periodontitis. The introduction of Nickel-Titanium rotary system has improved the technical quality. However, the overall treatment outcome of root canal treatments has not improved.
Root canal treatment has been shown to be associated with stress, anxiety and lack of control.
Aim: To investigate the experience of endodontic treatment among general dental practitioners with focus on difficulties and barriers.
Methods: A digital questionnaire survey was sent by email to general dental practitioners (GDPs) in five counties in northern Sweden. The participants were asked questions regarding general information and questions related to their endodontic work divided into three main groups; the patient, education and stress, time and material.
Results: The response rate was 58% (n=96). Sixty percent of the participants had a very or quite positive attitude towards endodontic treatment. Sixty-three percent often or sometimes experience stress when performing root canal treatment. Lack of time was frequently
answered as a cause of stress (59%). Most respondents had a good (40%) or quite good (54%) education in endodontics. Twenty-two percent of the GDPs felt very confident and 62% felt quite confident when performing root canal treatment.
Conclusion: The participants generally had a positive attitude toward endodontic work.
Although, stress was frequently experienced when performing root canal treatment, in many situations due to lack of time. Results from the present study indicates that education is of great value to further develop the dentists’ confidence in endodontics.
BACKGROUND
The Swedish dental health has improved during the last decades and continues to improve.
(Nordenram, 2012). Despite this, about 200000 root fillings are performed annually in Sweden (Försäkringskassan, 2019) for treatment of disease in tooth pulp and the
surrounding bone tissue. Toothache is strongly correlated to diseases in the tooth which is extremely exhausting for the affected individual (Swedish Council on Health Technology Assessment, 2010). The endodontic treatment is therefore important to perform not only for medical purposes, but also for the patient's quality of life (Hamasha AA, Hatiwsh A, 2013).
The complexity of the endodontic work
Treatment of disease in the pulp tissue is often a technically demanding procedure (Swedish Council on Health Technology Assessment, 2010). Compared to a regular tooth filling, there is no visual insight to the root canal and the dentist has to rely solely on the tactile ability and X-ray images. In addition, it is important to work under strict aseptic conditions to prevent bacterial contamination of the root canal. Bacterial infections in the pulp can in turn lead to pulp necrosis and subsequent inflammation of the surrounding bone tissue (Kakehashi, Stanley and Fitzgerald, 1965, Torabinejad and Walton, 2009). Good aseptic work is achieved by isolating the pulp-damaged tooth with the help of a rubber dam. In Scandinavian studies, it has been shown that 90-96% of all dentists reported routinely use of rubber dam
(Malmberg, Hägg and Björkner 2019, Koch et al., 2009).
Periapical periodontitis and substandard technical quality
Persistent apical periodontitis has in Swedish retrospective studies been found in 25-52% of root-filled teeth (Ridell et al., 2006, Frisk, Hugoson and Hakeberg, 2008). Substandard technical quality of the root filling has been shown to be strongly correlated with apical periodontitis (Ridell et al., 2006, Frisk, Hugoson and Hakeberg, 2008). Furthermore, the status of the tooth and jawbone is a significant factor in the outcome of the treatment results, where necrotic pulp and inflammation of the bone tissue results in a lower success rate (Sjögren et al., 1990).
Adoption of new technologies in endodontic work
Introduction of nickel-titanium rotary technique (Ni-Ti) has resulted in a higher proportion of root fillings with good quality (Koch et al., 2015, Dahlström, Molander and Reit, 2011). By comparing cleaning and shaping in curved root canals with either Ni-Ti rotary technique or hand instruments, the conclusion was in one study that Ni-Ti rotary technique resulted in better shaping of the canal, created less transportation of the canal and resulted in a shorter treatment (Schäfer, Florek, 2003). However, it has been shown in one study that machine
cleaning and shaping does not result in an improvement in the treatment outcome of
periapical periodontitis (Koch et al., 2015). Other studies also show that an improved quality of root fillings has not resulted in an improved treatment outcome of root fillings (Frisk, Hugoson and Hakeberg, 2008, Kirkevang et al., 2000). Inadequate coronal seal, overfilling, a distance of > 2 mm between the root filling and radiographic apex has been shown to be associated with periapical periodontitis (Ridell K et al., 2006, Sjögren et al., 1990).
Work-related stress
The time set aside for each patient treatment is limited. It has been shown that dentistry is a more stressful profession than other professions. Time constraints and running behind schedule have been shown to be causes of stress (Brødsgaard and Moore, 2001, Myers, 2004). In the study “Working in the dark; Swedish general dental practitioners on the complexity of root canal treatment” (Dahlström et al., 2017) 33 general dentists in Västra Götaland county in Sweden were interviewed, and the authors stated that dentists experience negative emotions such as stress, anxiety and lack of control during root canal treatments.
These feelings were declared to be arisen due to the demanding clinical procedure of root canal treatment with no clear visual insight, uncertainty in the dentist’s competence, complicated tooth (i.e. tooth with curved canals, distally placed tooth etc.), patients who do not cooperate and insufficient time to perform the root canal treatment, among other things.
Acceptance of suboptimal root fillings was investigated in one study by the same authors. In addition to evaluating the quality of the root fillings on X-rays, the interviewed dentists also addressed that the pulpal and periapical status, evaluation of the risk versus benefit of a re- doing of the root filling, and available personal and time resources were incorporated when deciding whether to accept or retreat a root filling that is not ideal. (Dahlström et al., 2018).
Aim and hypothesis
The aim of this study was to investigate the experience of endodontic treatment among general dental practitioners (GDPs) in public dental care in five counties in northern Sweden, with focus on difficulties and barriers. To be able to get more generalized conclusions from a larger cohort it was decided to perform a questionnaire study. By increasing the
understanding of difficulties that may be present, the opportunity to work towards better safety for the patients increases.
The hypothesis for this study was that general dental practitioners experience stress and have a negative attitude toward root canal treatment.
MATERIAL AND METHOD
Literature search
A literature search was performed on the database PubMed, using the following keywords;
“root canal treatment”, “endodontics”, “general dental practitioner”, “root filling quality”,
“stress”, “nickel-titanium rotary system” and “microscope”. Articles relevant for this study and written in English or Swedish and were available in full text were sorted out. From some of the articles found, we gathered other articles from the list of references. In addition, fundamental knowledge in the subject was acquired from the book “Endodontics principles and practice”, 4th edition, M. Torabinejad, R.E. Walton, 2009.
Data collection
A digital questionnaire survey using Textalk Websurvey was sent by email to the clinical managers working in public dental care in five counties in northern Sweden; Norrbotten, Västerbotten, Västernorrland, Jämtland Härjedalen and Gävleborg. The clinical managers were asked to send the questionnaire to their employed GDPs. The participants received an information letter (Appendix 1) together with the questionnaire (Appendix 2) with
information regarding voluntary participation and anonymity. The questionnaire contained 30 multiple-choice questions and some short answer questions divided into four parts;
general information about the participating dentist, education in endodontics, patient related questions and questions regarding stress, time and materials. A time limit of 5 weeks to answer the questions was set from the date the questionnaire was sent. After three weeks, a second email with a reminder to participate in the study was sent to the clinical managers.
The clinical managers received an email when the response time had ended, asking them to answer how many GDPs that had received the questionnaire to be able to determine the response rate.
Data analysis
The data was processed using IBM SPSS Statistics version 26. Blank answers were counted as missing values and were excluded in the descriptive analysis. Following tests were used when processing the data; Mann-Whitney test, Kruskal Wallis test and Fischer’s test. The statistical level of significance was set at 0.05, which means that p ≤ 0.05 was considered significant.
Question number 5 and 6 were excluded from the result due to a great variation in the answers, where some GDPs answered in number of hours and others in percentage, which made it difficult to present the result. Question number 18 (found in appendix 2) was discovered to contain an incorrect answer alternative, which was corrected after eight
responses were received. These eight answers were not included in the data analysis of this particular question.
Ethical considerations
The part of this degree project application concerning ethical reflections was approved by The Ethics Forum at the Department of Odontology at Umeå Universitet.
Personal information of the participants did not appear when compiling the questionnaires.
However, questions regarding gender, county of employment and year of graduation were asked. The participation was completely voluntary and anonymous, which was described in an information letter that was sent together with the digital questionnaire. By answering the questionnaire, the general dental practitioners accepted to participate in this study. Only the co-authors of this study were involved with handling the answers from the questionnaire.
RESULTS
General information
Out of the 167 general dental practitioners that were asked to participate in the study, a total of 96 recipients answered the questionnaire which resulted in a response rate of 58%. One questionnaire came back blank.
Descriptive general information regarding the participant can be found in Table 1. The distribution of the recipients among the counties was slightly varied, with most recipients from Gävleborg and fewest from Jämtland Härjedalen. A slightly larger proportion of women than men participated in the study, but there is no significant difference of the gender
distribution in the different counties. Most of the participants graduated from Umeå University. More than one third of the participants graduated in the last four years.
Twenty-one percent of the GDPs perform less than one root canal treatment every week, 35%
perform 1-2 root canal treatment, 31% perform 3-5 root canal treatment and 11% perform more than 5 root canal treatment per week.
Nineteen percent had always someone to consult on the clinic, 48% most often, 12%
sometimes, 15% usually not and 5% had never someone to consult on the clinic. Most of the GDPs (75%) had the opportunity to refer patients to an endodontic specialist. A difference can be noted between the counties regarding the possibility of referral to a specialist. In Jämtland Härjedalen, one out of four were able to refer and in Gävleborg about half of the GDPs (53%) had the possibility to refer to a specialist. All the participants in Norrbotten and Västerbotten and 90% in Västernorrland responded to a possibility of remittance to a
specialist. File fracture and perforation were the most common reasons when the GDPs always referred to a specialist (Table 2). However, a larger proportion of the GDPs responded that they never or rarely refer in these situations. No one answered that they always or often referred patient cases due to lack of time, and 70% stated that they never refer because of time constraints.
The patient
When asked about how different patient factors might affect endodontic work, 76% GDPs responded that pulp and root anatomy are quite or very important. Mouth opening ability was also considered quite or very important factor when performing root canal treatment by 78% of the GDPs, along with dental fear (65%) and general conditions (63%). The status of the pulp and periapical status was not as frequently answered to be an important factor (40%
respectively). The most difficult teeth to treat were maxillary molars (80%). Second most difficult were mandibular molars (39%) and thereafter mandibular incisors (21%).
The segment in the root canal treatment that most GDPs experienced to be most difficult was localization of the canals (71%). 7% of the participants experience no difficulties at all when performing root canal treatments.
Education
Most of the respondents felt that they had good (40%) or quite good (54%) education in endodontics, 3% had neither or good education, 2% had quite bad education and no one had bad education. Four percent of the GDPs had participated in 3-4 endodontic courses the last five years, 41% had participated in 1-2 endodontic courses and 54% had not participated in any endodontic course the last five years. Eleven percent had participated in an endodontic course at the clinic, 18% had attended in an endodontic course arranged by the clinic elsewhere, 5% had attended in an endodontic course by own expense and 7% had
participated in an endodontic course in other constellation. Twenty-two percent of the GDPs felt very confident in their competence when performing root canal treatment and 62% felt quite confident, 9% felt neither confident or unconfident, 6% felt quite unconfident and no one felt very unconfident when performing root canal treatment. A statistical significance was observed (P = 0.039) between confidence in their competence when performing root canal treatment and numbers of courses the GDPs had participated in. Eighty-six percent of the GDPs expressed that more endodontic courses are needed, especially involving new techniques and materials (79%). Fourteen percent did not reported a need for more endodontic courses.
Stress, time and material
More than one in three of the GDPs (35%) stated it is quite or very difficult to perform root
canal treatment, 44% reported it was neither easy or difficult and 21% reported it was quite or very easy to perform root canal treatment. Sixty percent of the GDPs felt very or quite positive towards endodontic treatment and 13% had a quite or very negative attitude towards endodontic treatment. The remaining 27% had neither a negative nor positive attitude. When asked to explicate their opinion on this, several GDPs expressed that their attitude on the root canal treatment shifted from each treatment, depending on the severity of the tooth and patient. There was no significant difference regarding the difficulty of root canal treatment and time in profession (P = 0.782).
Twenty percent of the GDPs often experience stress when performing root canal treatment, 43% sometimes experience stress and 37% usually not or never experience stress in this situation. No statistically significance (P = 0.697) was noted between frequency of
experienced stress and examination year. When asked about factors that causes stress, lack of time, difficult teeth and difficult patient conditions were frequently answered as a cause of stress (Table 3). There was a statistically significant (P = 0.017) that the GDPs feel more stressed if they experience that they have insufficient time to perform root canal treatments.
Most of the GDPs answered that they often or always had enough time (72%) to perform root canal treatment. Some dentists commented that they experienced shortage of time when treating patients in acute situations. The majority (56%) answered that they had the opportunity to influence the time required for root canal treatment to a great extent, 42%
could influence their time to some extent and 2% had no possibility at all to influence the treatment time. Seventy-six percent had the opportunity to choose which material and methods to use when performing root canal treatment to some or great extent. Many dentists commented that they prefer to use machine file system when cleaning and shaping and that it has facilitated the endodontic treatments.
DISCUSSION
The present study was based on a questionnaire survey conducted among general dental practitioners in five counties in northern Sweden. The results from the questionnaire generated quantitative data which could be used to generalize conclusions and apply those conclusions to a population. The main aim of this study was to investigate the attitude toward endodontic work amongst GDPs working in public dental care. Previous research regarding this subject is very limited, and no other similar questionnaire study has been made in Sweden which is the reason that this study was carried out.
In the present study, surprisingly more than half of the GDPs have a very or quite positive attitude towards endodontic treatment. This result contradicts the hypothesis that GDPs generally have a less positive attitude toward endodontics. Although, the majority of the
GDP’s experience root canal treatment as stressful frequently. One important factor
influencing the feeling of stress was lack of time, and there was significantly stated that the less time scheduled for root canal treatment the more stressed the GDPs felt. It has
previously been shown that shortage of time for treatment is one cause of experienced stress during root canal treatment (Dahlström L et al., 2017). Even though lack of time was a major cause of stress, most of the GDPs expressed that they often or always had enough time to perform root canal treatment, and the majority had the opportunity to influence the time required for root canal treatment to a great extent. These results are somewhat conflicting.
Based on the results, an evident explanation as to why the GDPs are experiencing this has not been found. One possible explanation could be that each root canal treatment is different from another and that each patient and tooth could be more or less difficult to treat. The time consumption may therefore vary and be difficult to predict beforehand, and thereby cause a feeling of stress.
The results from this study showed that lack of time, complicated tooth conditions and difficult patient conditions were factors that caused stress when performing root canal treatment. The time scheduled for each patient is more or less limited, and the dentist has to be able to treat a patient within this time due to the fact that a new patient is scheduled after.
In theory, it is possible to affect the time aspect, which in turn could facilitate difficult tooth conditions and patient conditions by having more time to take care of these situations. Good quality of the root filling is of great importance to achieve a good outcome in an infected tooth (Sjögren U et al., 1990, Ridell K et al., 2006). More time for each treatment could improve the circumstances for treating a difficult tooth, which in turn could lead to a better prognosis for infected teeth.
A great majority of the GDPs in this study responded that they would like to have the opportunity to attend more courses and training in endodontics. At the same time, the majority felt confident in their capability when performing root canal treatment. This could suggest that there are not necessarily deficiencies in knowledge, but rather a desire to further develop within the subject. It was shown in this study that the more endodontic courses the GDPs had attended, the more confident they felt when performing root canal treatment.
Previous studies have shown the advantages of postgraduate education in root canal treatment. Several programmes have been carried out in different parts of Sweden, where GDPs have been introduced and educated in usage of Nickel-Titanium rotary system. It has been shown that many GDPs have adopted this new technology and along with that, the technical quality has improved (Dahlström L, Molander A, Reit C 2011, Koch et al., 2015).
There has been an increase in the number of referrals received to the specialist department for endodontics in the Västerbotten county over the past seven years (Appendix 3). It is important to know why the number of referrals have increased to be able to reduce the queues to specialists in order for the patients who really are in need for specialist care to get treated on time. In the present study, the GDPs reported file fracture and perforation to be the most common reasons of referrals to a specialist. However, these cases are not widely referred based on the result of the present study. Removal of fractured files is difficult and requires a good insight and magnification to the root canal and the fractured file (Cheung G, 2009). This is enabled with a microscope, which is not available on all clinics and therefore a reasonable cause for referral. Further studies on this subject are required to gain a deeper understanding why the queues to endodontic specialists has increased in Västerbotten.
According to the participating GDPs, the most important factors that influence the
endodontic treatment were mouth opening ability, root- and pulp anatomy, dental fear and general conditions. The GDPs did not express that the status of the pulp and periapical status were significant factors for the endodontic work. One study where an expert group that consisted of specialists in endodontics responded that periapical status and infected root canal were of the greatest importance for the prognosis (Bjørndal L, Laustsen MH, Reit C, 2007). It has also previously been shown that the pulp and periapical status of the tooth affect the prognosis outcome of the root canal treatment (Sjögren U et al., 1990).
Root canal treatment is a demanding subject in odontology due to the procedure with limited visual insight to the root canal system (Swedish Council on Health Technology Assessment, 2010) and the need for extremely aseptic conditions in order to reach a good treatment outcome is of great importance (Bergenholtz G, Spångberg L, 2004). In the present study, the GDPs responded that localisation of the canals to be the most difficult step in the root canal treatment. A suggestion to facilitate this procedure could be to provide the clinics with a microscope and the GDPs with loupes, which gives the GDPs a better view of the pulp cavum and canal orifices (Yoshioka T, Kobayashi C, Suda H, 2002).
One limitation with this type of study method is that it is difficult to get a deeper understanding of the participants’ answers. This method lacks the possibility to clarify questions and answers to a greater extent, as well as the option of asking supplementary questions. One dentist may have a different view from another dentist on the various answer alternatives. Therefore, the interpretation in this study of the answers might not exactly match with the individual dentists' intended answer.
A potential flaw with the present study is the digital distribution method. It is possible that a paper survey could have resulted in a higher response rate. A paper survey distributed and
collected by the employer could be perceived more compulsory to respond to than an email with a questionnaire. It may also be possible that some GDPs experience an uncertainty regarding anonymity with a digital survey. In addition, there is an uncertainty about whether the email reached all dentists in the targeted area due to the intermediate step where the clinical officers were asked to forward the questionnaire to their employed dentists. It is also not known whether all the participants took part of the information letter that was included with the link to the questionnaire survey sent to the clinical officers. Although, the results from the questionnaires are nevertheless valuable since all participating GDPs answered based on their own thoughts and experiences. The large difference in number of participants in the different counties that was observed, with fewest participants from Jämtland
Härjedalen, may be due to the fact that another questionnaire in endodontics was sent at the same time to the GDPs in Jämtland Härjedalen and Västerbotten. Because of this, no
conclusions can be drawn based on the regional level.
One potential risk for misleading results with questionnaire surveys may be an
overrepresentation of participants who have a more positive attitude towards the subject of the survey. Among those who chose not to respond to the study, there could be a greater number who do not want to state their negative opinions about their own work role and lack of expected and acquired knowledge.
A goal with this study was to investigate what difficulties that may be present regarding endodontic treatment, and thereby give the opportunity for the different counties to be able to work towards a better safety for their patients. The present study indicates that GDPs want more education, and further studies are required to investigate in which areas education is needed, and what is lacking in the existing knowledge and skills. More studies are needed to find causes of referrals to a specialist in endodontics. More qualitative studies are also needed to gain a better understanding of what is lacking in the different regions in endodontic treatment.
CONCLUSION
The participating GDPs generally have a positive attitude toward the endodontic work.
Although, stress is a frequently experienced emotion when performing root canal treatment, in many situations due to lack of time. There is a desire for more education on the subject and the results from the present study indicates that education is of great value to further develop the dentists’ confidence in endodontics.
ACKNOWLEDGMENTS
The authors would like to thank Majid Ebrahimi, for the support involving the questionnaire study and writing of this paper, and Anders Esberg for guide in the statistical data analysis.
We would also acknowledge all clinical officers for distributing the digital questionnaire to their employed general dental practitioners. Last but not least, we would like to thank all dentists that responded and participated in our questionnaire study.
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Table 1. General information of participating general dental practitioners.
Year of gradua- tion
n % County n % Place of gradua- tion
n % Gender n %
2015-2019 33 35.9 Norrbotten 11 12.2 Umeå University
45 48.9 Female 57 60.6
2010-2014 15 16.3 Västerbotten 18 20.0 Karolinska Institute
24 26.1 Male 37 39.4
2000-2009 11 12.0 Västernorr- land
19 21.1 Göteborg University
10 10.9
1990-1999 9 9.8 Jämtland Härjedalen
4 4.4 Malmö University
3 3.3
Before 1990 24 26.1 Gävleborg 38 42.2 Other 10 10.9
Table 2. Reasons of referral to specialist and how often patients are referred.
Always Often Sometimes Rarely Never
n % n % n % n % n %
Deviant root anatomy
2 2.1 11 11.5 18 18.8 36 37.5 20 20.8
Obliteration 3 3.1 14 14.6 19 19.8 33 34.4 18 18.9
Multi-rooted tooth
0 0.0 2 2.1 3 3.1 23 24.0 59 61.5
Periapical inflammation
1 1.0 0 0.0 5 5.2 22 22.9 58 60.4
File fracture 18 18.8 9 9.4 14 14.6 29 30.2 17 17.7
Perforation 17 17.7 5 5.2 13 13.5 22 22.9 29 30.2
Reatreatment 2 2.1 6 6.3 15 15.6 24 25.0 40 41.7
Children 2 2.1 9 9.4 39 40.6 20 20.8 18 18.8
Lack of time 0 0.0 0 0.0 7 7.3 12 12.3 67 69.8
Insecurity 0 0.0 5 5.2 14 14.6 25 26.0 42 43.8
Table 3. Factors causing stress among GDPs when performing root canal treatment.
Yes No
n % n %
Lack of time 57 59.4 38 39.6
Difficult tooth 52 54.2 43 44.8
Difficult patient conditions 45 46.9 50 52.1
Available materials 7 7.3 88 91.7
Accident 3 3.1 92 95.8
Insufficient knowledge 4 4.2 91 94.8
Other reason 3 3.1 92 95.8
Appendix 1: Information letter
Attityder till endodontiskt arbete hos allmäntandläkare inom Folktandvården
Vid rotbehandlingar krävs en hög precision och en god aseptik. Tekniken har gått framåt och utvecklingen av maskinfilssystem möjliggör en större andel rotfyllningar med god kvalitet.
Trots detta ser man fortfarande i studier en stor andel kvarstående apikala inflammationer.
Vad finns det för faktorer som försvårar det endodontiska arbetet? Vilken är den generella inställningen till rotbehandling inom tandvården?
Vi heter Cajsa och Evelina och läser vår åttonde termin på tandläkarprogrammet vid Umeå Universitet. I vårt examensarbete vill vi undersöka hur allmäntandläkare inom
Folktandvården ställer sig inför rotbehandlingar och vi vill med denna enkätstudie få en fördjupad förståelse för vilka attityder allmäntandläkare har inför endodontiskt arbete med fokus på svårigheter som möjligtvis finns gällande detta.
Enkäten tar ca. 7-10 min att besvara. Det är självklart frivilligt att delta i denna studie. Vi är dock mycket intresserade av vad just Du tycker, och dina svar är värdefulla och kan inte utbytas av någon annans. Genom att svara på den medföljande enkäten ger du ditt
medgivande att använda dina svar i vårt examensarbete. För att få en representativ bild av inställning och attityder till rotbehandling ser ut bland allmäntandläkare inom
Folktandvården hoppas vi att du så gott som möjligt svara till fullo på alla frågor. Resultatet från denna studie skulle möjligen kunna leda till förändringar och en bättre arbetssituation för tandläkare verksamma inom den offentliga sektorn.
Svaren från dig kommer att bearbetas med full konfidentialitet. Detta betyder att din identitet inte på något sätt kommer att användas vid sammanställning av enkätstudien.
Dina svar kommer att analyseras och sammanställas för att ge en övergripande bild av den allmänna uppfattningen. Inga utomstående kommer att ta del av enkäterna.
Har du funderingar kan du kontakta oss, vi svarar gärna på dina frågor! Kontaktuppgifter finns nedan.
Tack på förhand!
Cajsa Jernström, tandläkarstudent Majid Ebrahimi, DDS, PhD caje0015@student.umu.se majid.ebrahimi@umu.se Evelina Svanelind, tandläkarstudent
evbe0036@student.umu.se
Appendix 2: Questionnaire
Allmänna frågor 1. Kön
a. Man b. Kvinna c. Icke-binär
2. Vilket län jobbar du i?
a. Norrbotten b. Västernorrland c. Jämtland/Härjedalen d. Västerbotten
e. Gävleborg
3. Vilket lärosäte har du examinerats från?
a. Göteborgs Universitet b. Malmö Universitet c. Karolinska Institutet d. Umeå Universitet e. Annat
4. Ange examinationsår:
a. 2019 - 2015 b. 2014 - 2010 c. 2009 - 2000 d. 1999 - 1990 e. 1989 eller tidigare
5. Hur många timmar av totala arbetstiden arbetar du i snitt per vecka med patientbehandling?
Ungefärligt antal timmar
6. Hur stor andel av ditt kliniska arbete består av endodontisk behandling?
Ungefärligt antal %
7. Hur många endodontiska behandlingar utför du i snitt/vecka?
a. < 1 behandling b. 1–2 behandlingar c. 3–5 behandlingar d. >5 behandlingar
8. Finns det någon på kliniken du kan rådfråga vid behov i samband med rotbehandlingar?
a. Ja, alltid b. Ja, oftast c. Varken eller d. Nej, oftast inte e. Nej, aldrig
9. Har du möjlighet att remittera till specialister?
a. Ja b. Nej c. Vet ej
10. Var vänlig och ange hur ofta du remitterar nedanstående.
Orsak Alltid Oftast Ibland Sällan Aldrig
Avvikande rotanatomi
Obliteration Flerrotiga tänder
Periapikal inflammation Filfraktur
Perforation
Revidering rotfyllning Barn
Tidsbrist
Osäkerhet
Utbildning
11. Hur säker känner du dig i din kompetens när du utför rotbehandlingar?
a. Mycket säker b. Något säker c. Varken eller d. Något osäker e. Mycket osäker
12. Upplever du att du har fått tillräcklig utbildning inom endodontiskt arbete?
a. Ja, god utbildning
b. Ja, ganska god utbildning c. Varken eller
d. Nej, ganska dålig utbildning e. Nej, dålig utbildning
13. Har du gått kurser/utbildningar för att förbättra dina kunskaper inom endodonti senaste 5 åren(flera svarsalternativ är möjliga)?
a. Ja, anordnade på kliniken
b. Ja, anordnade av kliniken på annan plats c. Ja, anordnade på egen bekostnad
d. Nej e. Annan:
14. Hur många kurser/utbildningar (efter högskoleutbildning) har du gått inom endodonti senaste 5 åren?
a. 0 b. 1-2 c. 3-4 d. >5
15. Tycker du att det finns ett behov av mer endodontikurser?
a. Ja b. Nej
16. I så fall i vilken del av endodonti?
a. Maskinell rensning b. Nya tekniker och material c. Bakteriologisk
d. Röntgenologisk e. Annan
Patienten
17. Hur ser din patientsammansättning ut?
a. Framförallt barn b. Framförallt vuxna c. Enbart barn d. Enbart vuxna e. Lika fördelat
18. Ange hur stor betydelse du anser att nedanstående patientfaktorer påverkar det endodontiska arbetet.
Faktorer Mycket
stor betydelse
Ganska stor betydelse
Varken eller
Ganska liten betydelse
Mycket liten betydelse
Allmäntillstånd Begränsad gapförmåga Tandvårdsrädsla
Pulpans status (vital eller nekrotisk)
Periapikalt status (inflammation eller inte)
Feber Svullnad
Fistel
Pulpan/rotanatomi Tidsbrist
19. Finns det några andra patientfaktorer som du anser kan försvåra det endodontiska arbetet?
Skrivfråga
20. Upplever du någon av följande tänder svårbehandlade vid rotbehandling?
Om Ja, markera vilka.
a. Ök molarer b. Ök premolarer c. Ök incisiver d. Uk molarer e. Uk premolarer f. Uk incisiver g. Inga tänder
21. Ange nedan vilka eventuella steg du upplever som svåra vid rotbehandlingar (flera alternativ är möjliga)
a. Entrépreparation b. Trepanation c. Cavumpreparation d. Kanallokalisation e. Rensning med handfil f. Rensning med maskinfil g. Applicering av inlägg h. Rotfyllning
i. Fyllning j. Annat:
k. Upplever inga svårigheter
Stress - tid - material
22. Hur ställer du dig inför rotbehandlingar?
a. Mycket positiv
b. Ganska positiv c. Varken eller d. Ganska negativ e. Mycket negativ
23. Utveckla varför du har den inställning som du har:
Skrivfråga
24. Hur upplever du att det är att utföra rotbehandlingar?
a. Mycket lätt b. Ganska lätt
c. Varken lätt eller svårt d. Ganska svårt
e. Mycket svårt
25. Utveckla varför du tycker som du gör:
Skrivfråga
26. Känner du dig stressad vid rotbehandlingar?
a. Ja, alltid b. Ja, ofta c. Ibland
d. Nej, oftast inte e. Nej, aldrig
27. Om du känner dig stressad, vad kan det bero på? (Flera svarsalternativ är möjliga)
a. Tidsbrist
b. Svårarbetad tand
c. Svåra patientförhållanden d. Material som finns tillgängliga e. Olycka i samband med rotbehandling f. Otillräckliga kunskaper
g. Annat:
28. Om du markerat någon av ovanstående alternativ, utveckla varför du känner dig stressad:
Skrivfråga
29. Upplever du att du har tillräckligt med avsatt tid att utföra rotbehandlingar?
a. Ja, alltid b. Ja, oftast c. Varken eller d. Nej, oftast inte e. Nej, aldrig
30. I vilken utsträckning har du möjlighet att påverka tidsåtgången för rotbehandlingar?
a. I stor utsträckning b. I viss utsträckning c. Inte alls
31. Om du svarat i viss utsträckning eller inte alls - skulle du vilja ha mer inflytande över tidsåtgången för rotbehandlingar?
a. Ja, i stor utsträckning b. Ja, i viss utsträckning c. Nej, inte alls
32. I vilken utsträckning har du möjlighet att påverka vilka material och metod som du ska använda vid rotbehandlingar?
a. I stor utsträckning b. I viss utsträckning c. Inte alls
33. Om du svarat i viss utsträckning eller inte alls - skulle du vilja ha mer inflytande över vilka material och metoder du ska använda vid
rotbehandlingar?
a. Ja, i stor utsträckning b. Ja, i viss utsträckning c. Nej, inte alls
Appendix 3: Referrals to specialists in Västerbotten county year 2012-2019
Klinik 2012 2013 2014 2015 2016 2017 2018 2019
ODR 4314 4565 4910 5352 5336 4988 4756 4721
ENDO 717 803 931 957 1125 1217 1270 930*
KOF 562 691 684 773 733 763 695 711
PAROD 40 428 491 598 644 561 608 539*
PROTETIK 598 631 599 610 630 613 625 568
CARIOLOGI 74 48 56 55
PEDODONTI 514 542 682 764 640 734 708 684
* Skellefteå saknas
