Why do dentists refrain from intervention in cases of persistent asymptomatic apical periodontitis in root canal filled teeth? An interview study among general dental practitioners

Abstract

Aim: To explore the context in which general dental practitioners (GDPs) decide to refrain from further treatment, that is, ortho- or retrograde retreatment or extraction of a root canal filled tooth with persistent asymptomatic apical periodontitis (PAAP).

Methodology: Fifteen GDPs were strategically selected for in-depth interviews. The informants were encouraged to describe in their own words and in as much detail as possible, the three most recent patient cases of PAAP of a root canal filled tooth, in which they decided to refrain from further treatment. The interviews were recorded digitally and transcribed verbatim. The collected material was analysed according to Qualitative Content Analysis with an inductive approach.

Results: A pattern of varying degrees of uncertainty associated with the decision process was identified. The motives to refrain intervention had great diversity. The result from analysis of the qualitative data was formulated in an overall theme 'Between doubt and certainty in a complex clinical context' covering the latent content. The first main category covering the manifest content was 'The continuum of confidence' with three subcategories 'Experienced uncertainty', 'Reluctant approval' and 'At ease with refraining' illustrating the feelings and attitudes experienced by the informants. The second category was 'In support of acceptance' with three subcategories 'Patient's autonomy, risks and cost-benefits', 'Emotional aspects' and 'Relieving measures' representing the reasons for refraining from intervention.

Conclusions: The decision to refrain from further treatment, that is, ortho- or retrograde retreatment or extraction of a root canal filled tooth with PAAP was made with some measure of confidence, combined with compensatory strategies to support the decision, taking into account not only values beneficial to the patient and awareness of limited external resources, but also factors related to the informants' personal preferences, convenience, concerns, ambition and emotions.

Keywords: [clinical] decision‐making; endodontics; periapical periodontitis; qualitative research; retreatment; tooth extraction.

FIGURE 1

Flow‐chart of recruitment of participants, reasons for not participating and final number of participants. GDPs, general dental practitioners.

FIGURE 2

Flow‐chart of text preparation and analysis of qualitative data, according to Qualitative Content Analysis (Graneheim et al., ; Graneheim & Lundman, 2004), specifying the authors' contributions.

FIGURE 3

Illustration of the results of the qualitative content analysis presenting the theme, categories, subcategories and examples of codes from in‐depth interviews. The interviews were conducted with 15 general dental practitioners and dealt with patient cases of persistent asymptomatic apical periodontitis of a root canal filled tooth, in which the dentist had decided to refrain from further treatment.