{"id":24926,"date":"2023-10-02T08:00:12","date_gmt":"2023-10-02T13:00:12","guid":{"rendered":"https:\/\/www.aae.org\/specialty\/?p=24926"},"modified":"2023-10-02T10:01:24","modified_gmt":"2023-10-02T15:01:24","slug":"treating-patients-with-disabilities-an-endodontic-perspective","status":"publish","type":"post","link":"https:\/\/www.aae.org\/specialty\/treating-patients-with-disabilities-an-endodontic-perspective\/","title":{"rendered":"Treating Patients with Disabilities – An Endodontic Perspective"},"content":{"rendered":"

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\nBy Caithlin Williams-Beecher, DMD, MSc<\/em><\/span><\/span><\/span>\u00a0<\/span><\/em><\/p>\n

Special Needs and Oral Health<\/strong><\/p>\n

Special needs can be defined as any physical, developmental, mental, sensory, behavioural, cognitive, or emotional impairment or limiting condition that requires medical management, health care intervention and\/or use of specialized services programs(1)<\/sub>. According to the World Health Organization(2)<\/sub>, approximately 1.3 billion people (16% of the world\u2019s population) experience a significant disability.<\/p>\n

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Fig. 1<\/p><\/div>\n


\nOral health is <\/span><\/span><\/span>being free from mouth and facial pain, oral and throat cancer, oral infections and sores, periodontal disease, tooth decay, tooth loss and other diseases<\/span><\/span><\/span> and disorders<\/span><\/span><\/span> (3)<\/span><\/span><\/span>. Of note, patients with special needs <\/span>exhibit<\/span> <\/span><\/span>a <\/span><\/span><\/span>higher risk <\/span><\/span><\/span>for<\/span><\/span><\/span> trauma, extensive caries and developing oral diseases. <\/span><\/span><\/span>Patients with special needs <\/span><\/span><\/span>oftentimes<\/span><\/span><\/span> have mental, <\/span><\/span><\/span>developmental,<\/span><\/span><\/span> or physical disabilities <\/span><\/span><\/span>that<\/span><\/span><\/span> may <\/span>render<\/span> them incapable of understanding, assuming responsibility for or <\/span><\/span><\/span>cooperating<\/span><\/span><\/span> with preventive oral care <\/span><\/span><\/span>procedures<\/span><\/span><\/span> (Fig. 2)<\/span><\/span><\/span><\/span>. These <\/span><\/span><\/span>conditions<\/span><\/span><\/span> allow <\/span><\/span><\/span>bacteria to enter the root canal system, resulting in pulpal inflammation or death and <\/span>periradicular<\/span> inflammation, which <\/span>necessitates<\/span> endodontic therapy to<\/span><\/span><\/span> retain<\/span> the affected tooth or teeth.\u00a0<\/span><\/span><\/span><\/p>\n

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Fig. 2<\/p><\/div>\n


\nEndodontic Outcomes in Patients with Special Needs<\/strong><\/p>\n

The life expectancy of patients with special needs is increasing and as such they require maintenance of a functional dentition to improve their quality of life(4,5)<\/sub>. However, in this population, some dentists prefer to extract teeth needing endodontic therapy rather than performing endodontic treatment due to potential difficulties in patient management (Fig 3).<\/p>\n

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Fig. 3<\/p><\/div>\n

<\/div>\n

Evaluation of the outcomes of endodontic treatment is a hotly debated topic with over 60 articles being published on the topic. On the contrary, despite there being so many studies and articles, very few address endodontic outcomes in patients with special needs. Within the literature, there are two main thoughts used to classify\/categorize endodontic outcomes \u2013success and survival. When considering that endodontic treatment has been successful, the treated tooth must be free from both clinical symptoms and either the absence of or reduction in the size of a pre-existing lesion(6)<\/sub> (Fig. 4).<\/p>\n

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Fig. 4<\/p><\/div>\n

<\/div>\n

Survival, as an outcome is in keeping with providing retention of teeth without any symptoms following endodontic therapy (Fig 5). However, the notion of \u2018survival\u2019 does not consider the presence or absence of disease itself(6)<\/sub>.<\/p>\n

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Fig. 5<\/p><\/div>\n

<\/div>\n

In a retrospective cohort study by Williams-Beecher et al.(7)<\/sub>, 108 teeth that had undergone initial treatment in 61 patients with special needs were evaluated. The majority of these cases (81.5%) \u00a0were managed without the need for\u00a0general anaesthesia<\/a>. The healing rate for initial endodontic treatment was 89.9% and, the primary prognostic factor was no restoration being present at follow-up. \u00a0In addition, teeth with a definitive restoration placed immediately after the completion of endodontic treatment showed a better healing rate.\u00a0 After a mean follow-up of 79.36\u00a0\u00b1\u00a059.6\u00a0months, the survival rate was 73% and was correlated with gender (male) and age (>40 years). The most common reason for tooth extraction was unrestorable\u00a0tooth fracture<\/a>, an event outside of the control of the clinician.<\/p>\n

Extraction vs Retention<\/strong><\/p>\n

There is no \u201chard and fast\u201d rule when deciding whether to extract or retain a tooth. Decisions should be done on an evidence-based case-by-case basis. Some factors to consider when making your final decision include the:<\/p>\n