Adequacy of Access Cavity Preparation Prior to Endodontic Referral

Objectives: In Kuwait, teeth requiring endodontic therapy are treated first by general dental practitioners who perform the pulpectomy, prepare the access cavity and refer the patient to specialty centers for completion of treatment. The adequacy of endodontic access cavity preparation by general dentists was investigated in this prospective, multi-center study. Methods: Consecutive cases referred for endodontic treatment in 4 specialty dental centers in Kuwait (Adan, Amiri, Jahra, and SCADS dental centers) within a 30-day period were evaluated by endodontic specialists at each center. Recorded information included tooth number, assessment of the adequacy of access cavity preparation, the reason the access cavity is inadequate, and evaluation of mouth opening as normal or limited. Descriptive statistics and chi-square test were used for analysis of the data. Results: Of the 555 cases referred for endodontic therapy during the study period, 271 (48.8%) had an inadequate access cavity preparation. Most teeth judged to have inadequate access cavity preparations had more than one reason for inadequacy identified, including small access that is insufficient for proper instrumentation (68.6%), residual caries (52.4%), and undermined enamel (37%). Perforations were found in 5.5% of cases, and were significantly more likely to occur in posterior teeth (p<0.05). No other differences related to tooth type were found. Limited mouth opening was present in 6.1% of patients, and was also significantly associated with inadequate access cavity preparation (p<0.05). Conclusions: Approximately one-half of teeth referred for endodontic therapy in Kuwait have inadequate access cavity preparations, which may lead to delays and complications in providing proper specialized dental therapy.