This research proposal will aim to determine outcomes of root canal therapy performed in permanent teeth in a pediatric population with a focus on healthcare disparities, value and the impact of clinician decision-making. This is significant because the most common endodontic procedure, root canal therapy, is performed over 15 million times annually in the US as management for tooth pain and infection. To date, the literature on root canal therapy outcomes in the US is based primarily on adult populations, even as children also undergo root canal therapy. Treatment of the permanent dentition in children differs from that of adults due to anatomical differences and behavioral factors. The most recent information available on endodontic procedure frequency is from the American Dental Association Survey of Dental Services Rendered, conducted in 2005-2006. The lack of information about endodontic procedure utilization, the absence of linkages to patient demographics, and the dearth of robust outcomes analyses for this treatment in a pediatric population highlight the need for updated, rigorous research in this area. To address this gap in knowledge and overcome limitations of previous studies, a mixed-methods approach will be used to evaluate multiple facets of the clinical management of dental pain and infection in children, specifically, 1) quantitative assessment of treatment and outcomes in a large, population-based sample; and 2) qualitative appraisal of clinician treatment planning and decision-making.
The specific aims of this career development award are to: 1) evaluate the prevalence and outcomes of root canal therapy of permanent teeth in a pediatric population and determine the factors associated with initial root canal therapy survival using administrative claims data from New York and Massachusetts; 2) Explore dental / emergency room (ER) utilization rates and spending associated with teeth that undergo root canal therapy; and 3) characterize factors affecting clinical decision-making for endodontic treatment of permanent teeth in the pediatric population through semi-structured clinician interviews. We will evaluate the associations of clinical characteristics, such as patient age, tooth type, practitioner type, time to restoration and type of restoration, with outcomes of root canal therapy. We anticipate/expect that disparities will vary by payer type and area- based poverty level and that clinical characteristics are associated with downstream utilization rates and cost of care. The qualitative exploration may reveal that 1) clinician?s comfort and expectations with treating the pediatric population, 2) clinician?s competency performing endodontic treatment, and/or 3) financial incentives are factors in the clinical decision-making process. With an integrated training plan that supports the investigative aims, this grant will provide the PI with the necessary support to become an independent clinician-investigator who investigates the comparative value of dental treatments with regard to outcomes, quality of life, and cost effectiveness.
This project will increase the generalizability of outcome studies of root canal therapy, a procedure that treats tooth pain and infection to save natural teeth, by using a mixed-methods approach to evaluate multiple facets of the clinical management of dental pain and infection in children. Specifically, the aims are to conduct 1) a quantitative assessment of treatment and outcomes in a large, population-based sample; 2) An exploration of utilization rates and spending associated with teeth that undergo root canal therapy; and 3) a qualitative appraisal of clinician treatment planning and decision-making. By focusing on an understudied group, children with permanent teeth; including previously unstudied regions of the United States; and evaluating how insurance type (public vs. private) and clinician decision- making impacts outcomes, this study and integrated training plan will allow for broadly generalizable findings that increase the potential for impact on clinical practice and dental policy.
