A retrospective, repeated, cross-sectional study assessing changes in the prevalence of apical periodontitis associated with the endodontic status and DMFT scores

Aim To compare the prevalence of apical periodontitis (AP), endodontic treatments, quality of endodontic treatments and their association with apical radiolucencies, and decayed, missing and filled teeth (DMFT) scores in patients attending a British NHS hospital in 2008–2009 (Cohort 1/C1) and 2018–2019 (Cohort 2/C2).

Methodology Randomly selected panoramic radiographs of 980 patients, evenly distributed into two cohorts: C1 (2008–2009) and C2 (2018–2019) were retrospectively analysed. Patient demographics, number of teeth, presence and quality of endodontic treatments, apical radiolucencies in treated and untreated teeth, endodontic treatment quality, AP prevalence by tooth type, and DMFT scores were compared.

Results C1 had significantly higher DMFT scores ( p <0.001). Patients with AP had higher DMFT scores and lower number of molars ( p <0.001). Similar percentages of untreated teeth had AP in C1 (3.4%) and C2 (2.9%) but at a patient level, C2 had significantly fewer endodontic treatments (48.2% versus 41.2%; p = 0.015), less apical disease (51%, versus 44%; p = 0.04) and fewer endodontically treated teeth (5.5% versus 4.2%; p = 0.007). The percentage of endodontically treated teeth with AP was similar (29.3% versus 27.9%). C2 patients had less unsatisfactorily obturated teeth (63.7% versus 57.6%) though this was not statically significant ( p = 0.072).

Conclusion A reduction of caries and endodontic disease burden and a slight improvement in the quality of endodontic treatments in the 2018/2019 cohort was observed. This was not accompanied by increased tooth retention suggesting that more extractions of salvageable teeth were undertaken in the latter cohort