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Oral health–related quality of life (OHRQoL) before and after endodontic treatment: a systematic review

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Abstract

Objectives

This systematic review was undertaken to determine the oral health–related quality of life (OHRQoL) before and after endodontic treatment.

Materials and Methods

Based on the PRISMA guidelines, electronic databases (n = 7) were searched and from 1038 citations, 16 papers were included in this review. Information on study design, sample size, intervention/treatment modality, methods of assessing OHRQoL, and the key findings were extracted and analyzed.

Results

Among the 16 studies, 3 were cross-sectional surveys, 9 were longitudinal studies, and 4 were randomized clinical trials. The cross-sectional studies reported improvements in OHRQoL following root canal treatment. Comparative longitudinal studies did not identify a significant association between improvements in OHRQoL and the method of root canal instrumentation or number of instruments used. Clinical trials found that improvements in OHRQoL were significantly associated with instrumentation technique, surgical-incision approach, and the application of platelet-concentrate during surgery. Several methods of assessing OHRQoL were employed with the most common being the Oral Health Impact Profile (OHIP), albeit using different versions.

Conclusions

The results of this systematic review indicate that the QoL of patients improved after endodontic treatment. Nevertheless, these results are limited to patients who seek endodontic treatment and cannot be generalized. The lack of well-designed observational studies with standardized assessment approaches, coupled with heterogeneity of study design and interventions, precluded quantitative synthesis.

Clinical relevance

Pragmatic clinical trials are more meaningful to understand patient-centered outcomes of treatment. This review shows that endodontic treatment does improve the QoL. However, future studies should use standardized tools and data reporting, which are critical to make meta-analyses possible.

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Author information

Authors and Affiliations

  1. Discipline of Endodontology, Faculty of Dentistry, The University of Hong Kong, 34, Hospital Road, Sai Ying Pun, Hong Kong, Hong Kong

    Prasanna Neelakantan

  2. Discipline of Dental Public Health, Faculty of Dentistry, The University of Hong Kong, 34, Hospital Road, Sai Ying Pun, Hong Kong, Hong Kong

    Pei Liu & Colman McGrath

  3. School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK

    Paul M. H. Dummer

Authors
  1. Prasanna Neelakantan
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  2. Pei Liu
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  3. Paul M. H. Dummer
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  4. Colman McGrath
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Corresponding authors

Correspondence to Prasanna Neelakantan or Colman McGrath.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Electronic supplementary material

Supplementary data 1

PRISMA checklist for selection process of articles (DOC 59 kb)

Appendix 1

Appendix 1

Table 3 Assessment of risk of bias for the studies included in this review
Full size table

Assessment of risk of bias for cross-sectional and longitudinal studies included in this review

The following criteria (Newcastle-Ottawa scale) was used to score each study that was included in this review.

A maximum of two stars (**) is awarded for item 1.

A maximum of one star (*) is awarded for items 2 and 3.

A maximum of five stars (*****) is awarded for the items “Outcomes measurement.”

  1. 1.

    Representativeness of sample (max. 2*)

    Evaluated by the sample generation methods and sample origin (e.g., community, specific population)

    1. a)

      Random sample of specific population groups*

    2. b)

      Random sample of individuals of a population (or community)**

    3. c)

      Non-random sample of specific population groups

    4. d)

      Non-random sample of individuals of a population (or community)

    5. e)

      No description of whether sample was random or not

  2. 2.

    Comparability (max. 1*)

    Evaluated by the presence of control group

    1. a)

      Presence of control group (without endodontic treatment)

    2. b)

      Absence of control group

  3. 3.

    Calibration for exposure (max. 1*)

    1. a)

      Calibrated examiner: *Description of training/calibration procedure

    2. b)

      Non-calibrated examiner: report of absence of calibration; report of calibration, but with no description of procedure; no report of whether calibration was performed

  4. 4.

    Outcome measurement (max. 5*) including outcome assessment tool; concealment; adjustment of confounding factors; and non-response rate

    Assessment tool for outcome (In this review, the outcome was impact of endodontic treatment on quality of life).

    1. a)

      Use of validated assessment tool*

    2. b)

      Use of non-validated assessment tool or databank records (secondary data)

Concealment for evaluation of outcome (In this review, the examiner was considered to be blinded to exposure (received or not received endo-treatment) when evaluating the outcome (quality of life)).

  1. 5.

    Adjustments for confounding factors

    1. a)

      Adjustment for confounder of outcome*

    2. b)

      Adjustment for second confounder of outcome**

  2. 6.

    Non-response rate

    1. a)

      Description of non-response rate*

    2. b)

      No description of non-response rate

Although references [32, 33, 36, 37] were performed with control groups for comparison of two treatments, we evaluated them using this risk of bias tool due to the absence of a negative control group (no endodontic treatment). Albeit this being an issue of ethical concern, this strategy was adopted to fit to the research question in this paper.

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Neelakantan, P., Liu, P., Dummer, P.M.H. et al. Oral health–related quality of life (OHRQoL) before and after endodontic treatment: a systematic review. Clin Oral Invest 24, 25–36 (2020). https://doi.org/10.1007/s00784-019-03076-8

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  • DOI: https://doi.org/10.1007/s00784-019-03076-8

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