Sivakami Rethnam Haug
Dr.odont. (Universitetet i Bergen), specialist in endodontics (University of Pennsylvania), associate professor. Department of Clinical Dentistry, University of Bergen, Norway. ORCID number: 0000-0003-1930-8542
Malin Brundin
Odont. dr, universitetslektor, Övertandläkare Endodonti. Institutionen för Ododontologi, Medicinska Fakulteten, Umeå Universitet, Sweden. ORCID number: 0000-0002-8747-3307
Jussi Furuholm
DDS, Specialist in Endodontics, Dental advisor, Patient Insurance Center. ORCID number: 0000-0002-9080-6272
HLT, EHL Päivi Siukosaari
DDS, PhD, University lecturer. Department of Oral and Maxillofacial Diseases, University of Helsinki, University of Helsinki. ORCID number: 0000-0003-1959-426X
Headlines
Endodontically treated tooth needs to last a lifetime and therefore root canal treatment has to be performed with precision the first time around.
A good knowledge of case difficulty and operator abilities can help DP decide on whether they want to treat a tooth or refer to a specialist.
The Nordic Endodontic Assessment Form places DP and treatment tooth into 4 categories A, B, C and D according to technical skills, theoretical knowledge, and use of tools by DP.
To make a referral, good communication with the patient is essential.
The referral needs to be done early in the treatment procedure.
Dental practitioners (DP) often perform endodontic treatment on teeth that are difficult and challenging. Endodontic treatment is sometimes associated with treatment related problems such as mishaps, procedural errors, iatrogenic errors, complications, accidents and in serious cases, malpractice. These mishaps in general are closely linked to case difficulty. Endodontics is the leading cause of dental malpractice claims. A new case difficulty evaluation form, the Nordic Endodontic Assessment Form is introduced here. This form places DP and tooth into 4 categories according to technical skills, theoretical knowledge and use of tools. Category A DP does not use magnification tools. Category B DP use some form of magnification aid, have experience in performing endodontic therapy, and complementary theoretical knowledge. Category C DP use dental loupes, has experience and special interest in Endodontics. Category D DP are either an Endodontists or DP with special training in Endodontics who use the dental operating microscope. With this Nordic Endodontic Assessment Form, DP can self-evaluate which category the tooth that needs treatment belongs, identify case difficulty and refer patients when there is a need for it. How to write a referral and what should be included is also discussed.
People prefer to keep their natural teeth throughout their lifetime. This demand has led to dental practitioners (DP) performing endodontic treatment on teeth that is difficult and challenging to treat. Endodontic treatment improves quality of life. Unfortunately, endodontic treatment performance is sometimes associated with treatment related problems. These problems are referred to as mishaps, procedural errors, iatrogenic errors, complications, accidents and in serious cases, malpractice. Endodontic mishaps in general are closely linked to case difficulty which may or may not have an effect on treatment outcome depending on the diagnosis and type of mishap []. Endodontic mishaps, procedural errors or iatrogenic injury can also be interpreted to be a result of ignorance or deficiency of knowledge []. On the other hand, accidents are injury caused by operators, for example 'sodium hypochlorite' accident. Complications can be due to any of the problems or patient related complications, for example allergic reactions Malpractice is defined as illegal, improper, or negligent professional behavior. Unfortunately, endodontics is the leading cause of dental malpractice claims in certain countries [].
When suspecting potential malpractice, the dental practitioner's level of performance at each stage is reflected with the complexity of the case, and whether a general standard of care is achieved. The most harmful consequences are observed in injuries related to irrigants or medicaments in endodontics, such as sodium hypochlorite accident or extrusion of calcium hydroxide beyond the apical foramen to cause damage to the neural tissue or sinus causing complications (figure 1A and B . These accidents are often evaluated as avoidable whereby DP have failed to follow the standard level of practice. However, fear of procedural errors or other endodontic mishaps should not deter clinicians from performing endodontic therapy [].
Evaluation of case difficulty
Factors leading to endodontic problems can be preoperative or operative. Failure to understand root canal anatomy and misdiagnosis are preoperative factors leading to endodontic problems. There are numerous operative factors. One of these is failure to treat the root canal either because it was not localized, or t
