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Influence of Restorative Dentistry Index Treatment Need on the Oral Health-Related Quality of Life Assessment among Patients
Receiving Endodontic Treatment: A cross-sectional study

health. RDITN-Endo score represents the patient’s tooth's perforated tooth, or complex root morphology. To date,
severity that requires endodontic treatment at studies that investigated gender influence on root canal
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presentation. Hence, it was hypothesised that patients anatomy have all documented insignificant differences
with higher scores of RDITN-Endo are expected to have a between genders. Hence, it is expected that gender does
poorer outcome. However, a higher RDITN-Endo only not influence endodontic treatment failure.
resulted in a greater perceived dental treatment need in the
patient and had no effect on either perceived oral health I n terms of OHRQoL, the absence of correlation
status or satisfaction with oral health. between gender and S-OHIP(M) in the current study was
contradicting to some studies that reported more positive
It was apparent that the absence of significant experiences of OHRQoL in males compared with females,
association between increased RDITN-Endo scores and for children and the elderly. 19,23,24 This difference could be
perceived oral health status or satisfaction with oral health due to the less meticulous nature of male patients in
were in accordance with the absence of significant regards to comfort, function, and appearance compared to
association between increased RDITN-Endo scores and S- female patients. This was documented among the
OHIP(M) scores. However, the significant association edentulous elderly, where male patients were often more
between increased RDITN-Endo scores and perceived satisfied with their denture comfort, function, and
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treatment need was not in accordance with the S-OHIP(M) appearance than female patients.
result. Upon closer look on the distribution of the RDITN-
Endo scores of all the questions of perceived current state A significant limitation of this study is the small
of oral health, it was noted that those who reported poor sample size obtained. This is most likely contributed by
oral health status and unsatisfactory oral health exclusively the lack of RDITN score among patients referred to our
belonged to the high RDITN-Endo score groups. This clinic. Consequently, it resulted in an imbalanced
situation influences the correlation computation, resulting distribution in terms of gender and age of the patients.
in insignificant findings for these two parameters. Future Caution is essential in interpreting the demographic
studies with a greater sample size might result in a influence on OHRQoL outcomes. As discussed previously,
different finding for these correlations. different relationships in terms of age might be possible
with the inclusion of a larger sample size.
In this study, increasing age is associated with
increased failure of treatment. This could be due to the Furthermore, failure of treatment being chosen
negative impact ageing has on the dentition and oral soft as the sole objective clinical outcome to support the
tissue. However, a systematic review of the endodontic RDITN-Endo effect on the OHRQoL may not be sufficient.
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treatment outcome among the elderly revealed no Although correlation between age variable and failure of
influence due to aging. This is due to the fact that studies treatment was observed in the simple linear regression
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reporting age prognosis included in the systematic review analysis, the odds ratio of this effect was modest. Inclusion
employs wide range of age groups, rendering it difficult to of other clinical outcomes such as clinical signs and
established the correlation. The contradicting result in the symptoms, pain scale from 1–10, radiographic findings,
current study could also be due to the small sample size and endodontic diagnosis have the potential to yield
collected. Furthermore, although significantly associated, different results on the RDITN-Endo.
the odds of ageing to cause failure of treatment are small.
Hence, it is premature to conclude the association of Finally, the cross-sectional nature of the current
ageing with failure of treatment from this study alone. study may also hinder understanding of the causational
relationship between RDITN-Endo with OHRQoL and
Meanwhile, in terms of OHRQoL, age does not failure of treatment. Accordingly, a long term longitudinal
show any association with S-OHIP(M) scores. This study may offer a more valuable interpretation on how
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contradicts a study by Shrestha et al. (2020) that reported RDITN-Endo influences the OHRQoL score and the
improved OHRQoL with age among the edentulous occurrence of treatment failure. However, the strength of
elderly. This was attributed to the fact that older patients the current study remains as a paramount preliminary and
were more likely to accept their fate and feel that the lack exploratory study that identifies the possibility of using
of teeth is a part of elderly life. However, since the study simple stratification methods such as RDITN-Endo to
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was done in an elderly population, the effect of increasing predict the quality of health outcome following endodontic
age on improvement of OHRQoL might only apply to treatment.
population belonging to this age group only. Hence, the
fact that the current study includes patients as young as 15 These preliminary data can be further elaborated
years old could be the reason why this effect was not in the future by exploring the varying quality of care by the
observed. individual dentist or clinic implied by the insignificant
effect of RDITN-Endo scores on both OHRQoL and
I n accordance to the current study, endodontic failure of treatment. Quality of care can vary between
treatment’s success rate has been reported to be unrelated endodontic or restorative specialists, usage of microscope,
to gender. 20–22 Factors that are known to influence success up to date equipment, interpersonal skill, clinician-patient
of endodontic treatment are mostly anatomical factors relationship, or choice of obturating material. Additionally,
such as vertical root fracture, fragile tooth, severe caries, patient variation such as their motivation may also be the

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