|Year : 2017 | Volume
| Issue : 1 | Page : 1-2
School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
|Date of Web Publication||25-May-2017|
School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Dummer P. Editorial. Endodontology 2017;29:1-2
Education, education, education…
A very successful 19th Scientific Congress of the Asian Pacific Endodontic Confederation (APEC 2017) combined with the 18th Indian Association of Conservative Dentistry and Endodontics and Indian Endodontic Society Postgraduate Convention, was held in Delhi, India, on April 6–8, 2017. During the meeting, a large number of participants from around the world were able to listen to subject experts speaking on a wide variety of topics relating to endodontology. It was a great pleasure for me to be a part of the event and to see so many enthusiastic practitioners, students, and academics, as well as members of the dental industry, taking part in lively debates and discussions on matters relating to the pulp and periapical tissues. Indeed, it was most gratifying to see the ever-increasing interest in endodontology and the various methods by which we can enhance the care of patients – be it through a better understanding of diseases and their sequelae or the use of new “gadgets” to treat teeth with endodontic diseases. I congratulate the organizers of the APEC 2017 for putting on such a magnificent event – congratulations!
Looking at the evidence presented at the APEC 2017, it is clear that both primary and secondary root canal treatment carried out to a high technical standard will result in healing of apical periodontitis in over 80% of cases. However, despite the increasing interest in endodontology and the rapid advances in technology seen in the recent times, there remains a problem with the quality of root canal treatment provided in general dental practice. Indeed, evidence from around the world suggests that the majority of teeth with root fillings have persistent or emerging posttreatment disease, and that far from curing apical periodontitis, root canal treatment carried out in general practice does not result in the restoration of the periapical tissues to health in the majority of cases, or put in another way, the treatment does not result in predictable healing. Of course, most of these teeth survive and are retained in the mouth (>90%), but it is evident from the literature that the majority (>50%) will be associated with disease, namely asymptomatic chronic apical periodontitis. Over time, a proportion of these teeth will give rise to local symptoms and signs (pain, swelling, sinus, etc.) and patients will have to endure a further course of treatment, whereas others will not even realize that they have a disease as they will have no signs or symptoms.
The impact of persistent disease associated with root-filled teeth on systemic health and well-being is not known, although evidence is emerging to suggest that there may well be links between chronic apical periodontitis and a number of health-related measures, such as cardiovascular disease. Thus, moving forward the challenge for the endodontic community is to firstly understand the potential links better between endodontic infection/disease and systemic health and secondly to improve the quality of care provided by general dentists when undertaking root canal treatment.
The first point can only be addressed by high-quality research, and many centers are now focusing on the outcome of root canal treatment not only at a local (tooth) level but also on a systemic health level. Clearly, we await more evidence on this critically important area.
The second issue of the standard of care delivered by general dentists can only be addressed through collaboration between dental schools, postgraduate institutions, the dental industry, and health-care providers, including government. An improvement in the quality of root canal treatment will not happen overnight as it requires not only changes within dental schools during undergraduate education, but will also require continuing professional development (CPD) of general dentists to enhance their knowledge and competence.
One important action that can be taken by dental schools is the implementation of guidelines for the undergraduate curriculum in endodontology. One example of such guidance is available from the European Society of Endodontology (ESE) (De Moor R, Hulsmann M, Kirkevang LL, Tanalp J, Whitworth J. Undergraduate curriculum guidelines for Endodontology. Int Endod J 46:1105-14). These guidelines are set out in a logical and comprehensive way with the endodontic curriculum being presented as a list of competencies that the graduating student will be expected to have achieved. It is essential that each dental school reviews its endodontic curriculum and benchmarks its current provision against these guidelines, and where necessary, makes enhancements to its programs to ensure that students are able to provide high-quality endodontic care on graduation.
The ESE has also set out minimum expectations for 3-year specialist postgraduate training programs in endodontology (ESE. Accreditation of postgraduate specialty training programs in Endodontology. Minimum criteria for training specialists in Endodontology within Europe. Int Endod J 2010;43:725-37). Once again, this document can serve as a tool by which training institutions can benchmark their provision to determine whether they align with and fulfill these minimum criteria – or whether the need to do further work to achieve the necessary standard.
Unfortunately, these undergraduate and postgraduate guidelines will not address directly the difficult problem of the CPD of the existing general dentists. As noted above, this group requires help and assistance in order for them to improve their care of patients in terms of root canal treatment so as to reduce the prevalence of posttreatment endodontic disease and thus minimize the pain and suffering endured by patients. Action on this front can only be initiated through collaboration between academics, dental societies, and local/national government to establish an effective program of CPD that provides the existing general dentists with the knowledge and skills to provide root canal treatments of a suitable quality.
As a final thought, it is important we all keep in our minds the expectations of patients that they will receive care of a suitable standard to prevent or cure apical periodontitis. Thus, as a minimum, our treatment must:
- Do not harm
- Address patients' chief complaint
- Provide the most cost-effective, long-lasting solution
- Be patient centered and take into account the preferences of the patient (and other stakeholders if relevant)
- Preserve the biologic environment while maintaining or restoring comfort, esthetics, and function
- Be based on scientific evidence
- Be within the capability (competence) of the clinician.