Clinical decision making for a tooth with apical periodontitis: the patients' preferred level of participation

J Endod. 2014 Jun;40(6):784-9. doi: 10.1016/j.joen.2014.01.045. Epub 2014 Mar 29.


Introduction: To effectively engage patients in clinical decisions regarding the management of teeth with apical periodontitis (AP), there is a need to explore patients' perspectives on the decision-making process. This study surveyed patients for their preferred level of participation in making treatment decisions for a tooth with AP.

Methods: Data were collected through a mail-out survey of 800 University of Toronto Faculty of Dentistry patients, complemented by a convenience sample of 200 patients from 10 community practices. The Control Preferences Scale was used to evaluate the patients' preferences for active, collaborative, or passive participation in treatment decisions for a tooth with AP. Using bivariate and logistic regression analyses, the Gelberg-Andersen Behavioral Model for Vulnerable Populations was applied to the Control Preferences Scale questions to understand the influential factors (P ≤ .05).

Results: Among 434 of 1,000 respondents, 44%, 40%, and 16% preferred an active, collaborative, and passive participation, respectively. Logistic regression showed a significant association (P ≤ .025) between participants' higher education and preference for active participation compared with a collaborative role. Also, immigrant status was significantly associated with preference for passive participation (P = .025).

Conclusions: The majority of patients valued an active or collaborative participation in deciding treatment for a tooth with AP. This pattern implied a preference for a patient-centered practice mode that emphasizes patient autonomy in decision making.

Keywords: Apical periodontitis; dentist-patient relations; patient preference; personal autonomy; principle-based ethics; shared decision making.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cooperative Behavior
  • Decision Making*
  • Dental Prosthesis, Implant-Supported / psychology
  • Dentist-Patient Relations
  • Denture, Partial, Fixed / psychology
  • Denture, Partial, Removable / psychology
  • Educational Status
  • Emigrants and Immigrants / psychology
  • Female
  • Health Behavior
  • Health Services Needs and Demand
  • Humans
  • Income
  • Male
  • Middle Aged
  • Patient Participation*
  • Patient Preference*
  • Periapical Periodontitis / psychology
  • Periapical Periodontitis / therapy*
  • Personal Autonomy
  • Root Canal Therapy / psychology
  • Socioeconomic Factors
  • Tooth Extraction / psychology
  • Young Adult