Fighting the fear of endodontic failure – Mark Allen Coltene

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  Posted by: Dental Design      23rd March 2019













According to a survey of over 1000 dentists from a dental indemnity provider, an overwhelming majority worry about being sued by a patient.[i]Respondents also claimed that the fear of legal reprisals has impacted on the way they practice (74 per cent) and that this had caused them work-related stress and anxiety (77 per cent).

This survey is of course a snapshot and we must always look behind the headlines. Is dentistry a challenging and stressful environment? Yes. Are more dentists carrying out technically demanding treatment in their practice? Yes. Does the modern patient have high expectations? Yes. Are patients bombarded with advertising from companies who promote the ease at which they can make a malpractice claim? Yes! 

This is not meant to be flippant. Our patients might have high expectations but they are not always unrealistic; they can easily learn about every procedure and find out what the final outcome shouldbe. All outcomes come under one umbrella term and that is ‘functionality’. Being able to use the teeth for the functions that they are designed to perform – from chewing, grinding and crushing food to talking and smiling with confidence – is ultimately the desired outcome of every single dental treatment. A truly healthy mouth is one with functional dentition.

Endodontics is a channel of dentistry that has historically been a key area for attracting malpractice claims.[ii]The European Society of Endodontology (ESE) has guidelines for good practice, which include recommendations for a broad range of areas from record keeping to the maintenance of pulp vitality; the avoidance of endodontic failure is also a key topic at conferences and professional meetings. Past articles have questioned if a 100 per cent success rate is even possible in endodontics.[iii],[iv]Yet more and more patients want their natural teeth to remain in function and to avoid extraction.Is the endodontic dentist in a precarious position, then? How is the best way to communicate to patients the risk of failure in a way that empowers them with a clear understanding of the proposed treatment, so that consent can be established?

Of all the risk components involved in endodontics, not all of them can be managed. If the canals are very narrow, even an experienced dentist may find access difficult on an initial visit. Recurrent decay, or the tooth being periodontally compromised may have led to leakage of the restoration. A restoration can of course fail for a number of reasons, and long-term stability will depend on a number of factors from material selection to the patient’s own behaviour and their willingness to maintain their oral health.

It is rare that a patient who hears the words ‘root canal’ will dance with joy. Therefore a skilled clinician will be able to help them to understand the complexity of the procedure, while securing their consent. They should know that by going ahead they will not only keep their own tooth, but also that the infection causing them pain will be eliminated.

Headlines may stoke the fire of the fear of litigation, but successful endodontic work that has led to happy patients is more common that unsuccessfulprocedures and retreatment. Excellent treatment planning, processes and protocols that ensure good record keeping and knowing that you have done all you can to communicate to patients the bigger picture and therefore feel secure in the knowledge that you have obtained their full consent – these are the tools that will give you confidence. They will also protect you. Keeping your skill set, training and knowledge up-to-date if you are performing these procedures goes without saying, but knowing when to refer to a dedicated endodontist is also a key part of successful treatment. If retreatment is deemed necessary, for whatever combination of factors, the patient should understand that a specialist will then see them to fix the problem. This ensures that standards are kept as high as they possibly can.

Material and tool selection is also important. Sourcing premium materials will give you and your patients reassurance. COLTENE has a range of high-quality endodontic products, including the HyFlex™ EDM NiTi files and CanalPro™ irrigation solutions, to help facilitate successful working.The use of the rubber dam in contemporary endodontics is still a topic of debate (despite recommendations from the ESE and also the American Association of Endodontists). However, an article in 2015 indicated that less than half a sample of around 1,500 US dentists routinely used a rubber dam for root canal work.[v]Supporters of the rubber dam say its use gives accessibility, reduced operative time and a better containment of potential irritants.[vi]

Successful endodontic treatment is technically demanding, even for experienced practitioners. But by embracing the challenges and arming yourself with the right skills, processes, materials and support, you can build and maintain root canal confidence.


To find out more visit, email call 01444 235486


[i]Dental Protection survey reveals 9 in 10 patients fear being sued by patients. Dental Protection, 17 October 2018. Link: November 2018).

[ii]Webber J. Risk management in clinical practice. Part 4. Endodontics. British Dental Journal. 2010 Aug; 209 (4): 161.

[iii]Field JW, Gutmann JL, Solomon ES, Rakusin H. A clinical radiographic retrospective assessment of the success rate of single visit root canal treatment. InternationalEndodonticJournal. 2004 Jan; 37 (1): 70-82.

[iv]Lazarski MP, Walker III WA, Flores CM, Schindler WG, Hargreaves KM. Epidemiological evaluation of the outcomes of nonsurgical root canal treatment in a large cohort of insured dental patients. Journal of Endodontics. 2001 Dec 1; 27 (12): 791-6.

[v]Gilbert GH, Riley JL, Eleazer PD, Benjamin PL, Funkhouser E. Discordance between presumed standard of care and actual clinical practice: the example of rubber dam use during root canal treatment in the National Dental Practice-Based Research Network. BMJ open. 2015 Dec 1; 5 (12): e009779.

[vi]Emery C. Rubber dam: an overview. Vital. 2012 Nov 23; 10 (1): 29-33.


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