title: Patients' Values Related to Treatment Options for Teeth with Apical Periodontitis.
abstract: BACKGROUND
  This study aimed to explore patients' values when selecting treatment for a tooth with apical periodontitis (AP), namely retention via root canal treatment (RCT) and extraction without replacement or replacement with implant-supported crowns or fixed or removable partial prostheses.
  
  
  METHODS
  Through 2 surveys of patients (800 university patients and 200 community patients, response rate = 43%) and dentists (498 Ontario endodontists, periodontists, prosthodontists, oral and maxillofacial surgeons, response rate = 40% and 1983 Ontario general dentists, response rate = 15%), the importance of values that might be considered important to patients when selecting treatment options for a tooth with AP were recorded. Chi-square and Kendall's tau tests were used to respectively compare the importance rating frequency by each surveyed group and its correlation to their demographic variables (P ≤ .05).
  
  
  RESULTS
  Patients considered communication and trust (94%), tooth retention (90%), esthetic outcome (84% regardless of location), cost (83%), longevity (83%), and preoperative pain (81%) as the most important decision values. Dentists overrated the importance of patients' previous experience with the treatment options (94% vs. 72%), dental insurance (90% vs. 70%), and intraoperative pain (79% vs. 60%) while underestimating the importance of maintenance cost (60% vs. 79%).
  
  
  CONCLUSIONS
  Dentists should respect patients' views about esthetic outcome, longevity, and cost associated with treatment options for a tooth with AP. In particular, this survey highlights the value of communication and trust between patient and dentist and preservation of the natural tooth through RCT over implant-supported crown replacement when planning treatment for a tooth with AP.
authors.affiliation: Discipline of Endodontics, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; Discipline of Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, Ontario, Canada. Electronic address: amir.azarpazhooh@dentistry.utoronto.ca.
authors.forename: Amir
authors.initials: A
authors.lastname: Azarpazhooh
authors.affiliation: Discipline of Prosthodontics, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Thuan
authors.initials: T
authors.lastname: Dao
authors.affiliation: Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Program of Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Wendy J
authors.initials: WJ
authors.lastname: Ungar
authors.affiliation: Discipline of Endodontics, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jose
authors.initials: J
authors.lastname: Da Costa
authors.affiliation: Discipline of Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Rafael
authors.initials: R
authors.lastname: Figueiredo
authors.affiliation: Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Murray
authors.initials: M
authors.lastname: Krahn
authors.affiliation: Discipline of Endodontics, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Shimon
authors.initials: S
authors.lastname: Friedman
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003142:Communication; D003657:Decision Making; D019094:Dental Prosthesis, Implant-Supported / Q000523:psychology; D003815:Dentists; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D057240:Patient Preference; D010485:Periapical Periodontitis / Q000523:psychology* / Q000628:therapy*; D012390:Root Canal Therapy / Q000523:psychology; D014081:Tooth Extraction / Q000523:psychology
keywords: Apical periodontitis; dentist-patient relations; patient preference; personal autonomy; principle-based ethics; shared decision making