Endodontics

Abstract

Quality is commonly misunderstood as being equivalent to excellence. In the current health care debate quality is understood as the meeting of standards of treatment. The standards applied may be those thought most appropriate by the patient or the dentist or the purchaser of the care. Quality is therefore about meeting standards. In endodontics the issue of which standards should be applied, is problematical. This is because most of the means of assessment presently available are prone to error and the disease being treated is invisible to the patient and often pain-free for long periods of time. It is well-established that most diagnostic tools in endodontics have poor reliability especially in indicating the presence of pulpoperiapical disease. Root canal instruments, the essential tools of endodontics, show poor consistency in their cutting properties even though they may meet simple standards of size and shape.1 The widely accepted tenet of endodontic treatment, that canal cleansing is of paramount importance, suggests that root canal cleanliness should be measure of quality but this cannot be effectively measured clinically. This has resulted in the resort to alternative criteria such as the quality of canal filling which can be estimated subjectively from radiographs. The most appropriate test of quality would be an assessment of apical healing or health following treatment. This again has to be estimated largely from radiographs, and the reading of radiographs is prone to considerable error.2 It is also true that the apical tissue response can vary considerably between patients, often in ways that are not understood. The question of which standards should be adopted is therefore complex. In the past it has been the practice for standards to be set by the professional often with little reference to the patient or the purchaser.3 The lack of reliable tools to assess quality in endodontic treatment highlights the importance of considering the patient's and purchaser's standards as well as the consideration of professional standards for the provision of high quality treatment.