In the UK, the majority of dental care is provided by GDPs, with primary care delivered through a blend of NHS and private services. However, sometimes GDPs must refer patients to specialists. A skill gap remains between GDPs and specialist endodontists. Whilst GDPs do have the ability to refer patients in more complex cases, there are a limited number of specialists in the UK, with 324 endodontic specialists currently registered with the General Dental Council. As such, it is important to promote endodontic education to all dental professionals, to help all dentists with an interest in endodontics enhance their skills, and to provide endodontic treatment with confidence.
Addressing the problem
Clinicians with limited experience or education in endodontics may face problems when assessing more complex cases. In some situations, this might lead to misdiagnosis or inappropriate treatment planning. Should this happen, the underlying issue may not be properly addressed, resulting in treatment failure. If treatment fails, patients may experience more pain and infection and require re-treatment or an extraction. Treatment complications such as these can result in a bad experience for the patient, potentially weakening trust. They can also increase the requirement for corrective treatment by specialist endodontists.
Barriers to training and equipment
Further barriers arise for GDPs who may not have access to or be familiar with more advanced equipment. Modern endodontic technology, such as operating microscopes, ultrasonic instruments, and advanced imaging technologies, vastly improves endodontic outcomes, and limited use of these may hinder clinicians’ treatment successes.
Without the training and equipment that they need, clinicians may be unable to execute root canal treatment with precision. This might lead to complications caused by the insufficient removal of infected tissue and incomplete sealing of the canals, making treatment failure more likely. Should complications occur, patients will, again, need to be referred for more advanced treatment by a specialist – raising the overall cost of treatment and extending the duration.
Specialist endodontists are likely to have far more access and training surrounding these equipment types, enabling them to carry out more complex treatments.
Complications and complex cases
There are a range of possible complications or complexities that can necessitate referral to a specialist. For example, calcified canals, anatomical anomalies, and errors during treatment (like instrument fractures or perforations) require a level of expertise that a GDP may not possess. If these complications or complex cases are not managed appropriately, they may lead to further issues for the patient, potentially resulting in tooth loss. As such, clinicians must ensure they have the level of training, experience, and expertise required to tackle the cases they treat. Failure to do this may result in legal repercussions, and massively impact patient satisfaction.
In many complex cases, it can be useful to work alongside more experienced colleagues. This offers the opportunity for learning, whilst ensuring that patients receive the most appropriate treatment for them. By joining a network of specialist endodontists and dentists with a special interest in the field, GDPs gain useful insights in endodontics, access enhanced education, and get the opportunity for mentorship from leading figures in the field.
The British Endodontic Society (BES) strongly encourages any dentist, no matter their level of experience in endodontics, to become a member of the society to take part in events and educational opportunities within a supportive community. The BES prioritises education surrounding endodontics, with its ‘Guide to Good Endodontic Practice’ setting out clear guidelines for those providing endodontic treatment. Additionally, the BES offers tailored support to those at the beginning of their endodontic journey, through the Early Career Group, whilst also offering support to teachers through the Teachers of Endodontology Group. Each of these groups aim to enhance knowledge in the field and promote the development of its members.
Education and standard clinical guidelines are essential for enhancing knowledge of endodontics amongst the profession, and ensuring the most appropriate care is provided to patients. Overall, the promotion of education, training, and good practice further improves the overall quality of endodontic treatment in the UK.