Root Canal Treatment: National Study Says Most General Dentists Do Not Follow Standard Of Care Guidelines

A large national study of dentists conducted by the National Dental Practice-Based Research Network has found that only 47 percent of dentists always use a dental dam during root canal treatment, with an additional 17 percent using it 90 to 99 percent of the time, according to a recent scientific publication in BMJ Open. 

Using a dental dam during all root canal treatment is considered the standard of care, based on recommendations in standard dental textbooks and by the official policy of root canal specialists, the American Association of Endodontists. Using a dental dam during root canal treatment enhances patient safety and optimizes the odds of successful treatment.

The Study

In this study, 1,490 general dentists who represent a diverse range of dentist characteristics, practice types and patient populations served, completed an anonymous questionnaire about dental dam use and their attitudes toward its use. The study found a substantial variation in dental dam use and attitudes.

Beliefs that dental dam use is inconvenient, time-consuming, not effective, not easy to place or affected by patient factors were independently and significantly associated with lower use of a dental dam, said Gregg Gilbert, DDS, MBA, professor and chair of the Department of Clinical and Community Sciences in the UAB School of Dentistry. These attitudes explain why there is substantial discordance between presumed standards of care and actual practice.

The study explains that, based on the survey results, clinicians often say their experience is that they have not had problems as a result of not using a dental dam, and that a dental dam can be difficult to place or is not wanted by patients. Some dentists reported that they use other ways to isolate the tooth being treated that they feel are safe and effective. Others questioned whether the scientific evidence is strong enough that dental dam use is the only way to increase the odds of successful treatment.

Other general dentists felt strongly that a dental dam should be used in every case, and they encourage patients to become advocates for their own care by asking that a dental dam always be used during root canal treatment.

The National Dental Practice-Based Research Network, of which UAB is the national administrative center, is a national consortium of dental care providers and dental organizations that conduct studies to better inform clinical decision-making. Gilbert, who also serves as national network director, says the network seeks to inform policy, but does not make or recommend policy.

The study calls into question whether there really is a standard of care in this aspect of dental care, given that most general dentists are not following that standard.

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