Patient‐related outcomes and Oral Health‐Related Quality of Life in endodontics

Abstract

There is increased interest in outcome measures that complement the classic goal of endodontics, being the prevention and healing of apical periodontitis. Possible outcome measures can be subdivided into patient‐centred outcomes (PCOs), encompassing data collected by nonpatients aiming to assess the effectiveness of an intervention and patient‐reported outcomes (PROs), which are reported directly by the patient. PROs can be subsequently classed into PRO measures that ascertain patients' view of their symptoms, their functional status, and their health‐related quality of life, and patient‐reported experience measures that focus on aspects including the humanity of care, patient satisfaction, patient preference and adherence, personal costs, expectation fulfilment, and decision regrets. The present review aims to define various patient‐related outcomes and discuss the literature available regarding PCOs and PROs in endodontics. This includes those proposed to assess the effectiveness of endodontic treatment for pulpitis and apical periodontitis for use in the development of European Society of Endodontology S3‐level clinical practice guidelines that have been included by all working groups, except for the radiographic assessment of apical periodontitis. Based on limited evidence in the field, it can be summarized that after recall periods of various lengths, endodontic treatment is associated with a high likelihood of tooth survival and limited need for further intervention, including extraction and further restorative procedures. Oral Health‐Related Quality of Life (OHRQoL) is likely to improve following the completion of treatment. Nonetheless, the literature assessing the association between OHRQoL and endodontics is hampered by the use of instruments that have not been previously validated. Amongst the remaining outcome measures discussed in the present review, it is worth highlighting that there is only one study assessing exacerbations in teeth with the presence of endodontic pathosis, which suggests a very low incidence of this adverse effect following endodontic treatment. Patients' expectation fulfilment, adherence, and satisfaction are closely inter‐related and depend also on various nonclinical factors. Further studies assessing PCOs and PROs, in association with healing and prevention of apical periodontitis, are required to better understand endodontic treatment from the perspective of patients.

Dental patient‐reported outcomes following traumatic dental injuries and treatment: A narrative review

“…Within dentistry, pain is often measured by various tools and methods (e.g. numerical rating scales) that make comparisons between and across different studies difficult 5 . On the contrary, the Oral Health Impact Profile (OHIP) is a global instrument with established validity, reliability and precision that not only assesses pain, but also functional limitations, handicaps, and psychological discomfort, as well as physical, psychological and social disabilities in relation to an oral disorder, thus enabling measurement of an individual's Oral Health‐Related Quality of Life (OHRQoL) 6 .…”

“…The effect of TDIs on OHRQoL is complex and should take into consideration several clinical and non‐clinical variables. OHRQoL is a global outcome measure encompassing functional limitations, oral symptoms and emotional and social impacts 5 . TDIs may affect the OHRQoL of participants and also that of their families and/or carers 38–42 …”

“…Pain in endodontics has been defined as a ‘multifactorial noxious experience that involves a sensory response that can be modified by cognitive, emotional and motivational influences related to past experience’ 74 . Pain can be spontaneous or it can be elicited by touching the tooth and/or the related soft tissues, with the latter often defined as ‘tenderness’ 5 . In dentistry, pain is an important dPRO as well as having an influence on the Oral Health Impact Profile (OHIP) tool 6 and on one of the four dimensions of the OHRQoL (orofacial pain) 3 .…”

“…Patient‐related factors that can also determine the number of appointments include proximity of the patient's residence to the clinic, 5,97 availability of appointments 5 as well as patient preferences for the number of visits as there may be a desire to limit absence from work, particularly when this is related to loss of earnings 5 . Thus, consideration of both clinical and patient‐related factors is essential when deciding on the number of visits required in order to ensure that patients may experience high levels of satisfaction 5 . Furthermore, the time involved in dental visits can be categorized as direct (involving professional healthcare providers) and indirect time (involving companions, e.g.…”

“…Patient involvement in outcomes research 'may improve the relevance of research questions', 31 with consideration of dPROs in conjunction with clinical outcomes being essential to ensuring a 'greater understanding of patient priorities, preferences, values, expectations, and experiences'. 5 Otherwise, if a clinician's viewpoint is used to interpret a patient's perspective of treatment, valuable information from the patient's point of view on the effectiveness of treatment risks being overlooked, leading to patient dissatisfaction due to unfulfilled expectations and a perception of being ignored. 5 The advantages of using dPROs following treatment of TDIs includes [32][33][34][35] • Providing a more comprehensive view of treatment benefits and costs to aid clinicians and patients to select the most suitable treatment.…”