Clinic A Quality Assurance Report (Ongoing) ENDODONTIC THERAPY
I. Identified problem Endodontic (root canal) therapy is a treatment of last resort offered to patients desiring to save their tooth. Root canal therapy is generally needed as the result of a significant fracture of a tooth, dental abscess and necrosis of the dental pulp, or pulpitis that is deemed to be irreversible. The alternative treatment for endodontic therapy is to extract (pull) the affected tooth.
Prior to root canal therapy, the dental provider explains to the patient the factors that contribute to the failure of endodontic therapy, including instrument failure, crown or root fractures, pulp stones, failure to keep the obturation (fill) appointment, and the severity of the periodontal and periapical infection on the tooth. An Informed Consent is obtained to the patient prior to endodontic therapy.
II. Prevalence The IHS Dental Package of the Resource Personnel Management System (RPMS) contains a quality assurance tracking mechanism, which provided the necessary data to tracked failed endodontic therapies.
An endodontic failure is characterized by the extraction of an endodontically-treated tooth within the first five years of initial treatment. According to Pathways of the Pulp (Cohen, Burns), approximately 20% of all endodontic therapies fail in the first five years after treatment. The IHS Endodontist has stated that more than 80% of all endodontic therapies performed in the IHS fail within the first five years, and has set an IHS standard of 20% as the success rate for endodontic therapy. Clinic A has set, through the Clinical Standards of Care, a standard (and Benchmark) of 50% for the success rate of endodontic therapy.
Since January 2004, a total of 233 endodontic therapies have been initiated at Clinic A. Of these, 16 have met the definition of failure for patients that have re-presented to the clinic (patients are endodontically recalled at 12-month intervals routinely). Thus, the endodontic failure rate for the past 7 years is 6.9%, far better than what has been reported in the IHS (80%), the Clinic A Program Standard (50%), and the National Standard (20%).
III. Review/Corrective Action Though the standards are being met, it is the goal of the Clinic A to further improve the success of endodontic therapy provided at the Dental Clinic. Therefore, the following actions are planned to improve patient outcomes for this procedure:
Case selection – second molar endodontic therapy will be discontinued, as the majority of the failures over the past seven years (n=9) has been on these teeth.
Coronal coverage – the success of endodontic therapy depends heavily, especially in posterior teeth, on coronal coverage (crown or gold onlay) following endodontic therapy. Therefore, only patients with the ability to pay from crowns or onlays will receive endodontic therapy, as coronal coverage is in essence part of the root canal procedure.
IV. Re-evaluation A more thorough evaluation of endontic therapy failure will be assessed one year following the incorporation of the corrective action plan, and each year thereafter, utilizing the RPMS QA system.