Reduction of Flare-up in Root Canal Treatment: An Improved Treatment
Flare-up in root canal treatment (RCT) is considered an alarming issue at the Kangar Dental Clinic. It causes patients to experience severe pain or swelling, leading to an impromptu visit to the clinic in distress. This quality improvement study aimed to reduce the flare-up during RCT in Kangar Dental Clinic to ≤ 10% in 12 months. The 6-month census from January 2016 to June 2016 showed an incidence rate as high as 70%. The contributing factors identified were the use of improper RCT technique (96%), inter-appointment duration of more than 30 days (88%), and poor awareness and knowledge among dental personnel on recent techniques (70%). These findings were collected from the patient’s card, RCT assessment form, and appointment book. Remedial measures were implemented from July to December 2016, followed by a reevaluation from January to June 2017. A flowchart of RCT was developed via the use of rubber dam for tooth isolation, 2.5% sodium hypochlorite (NaOCl) as irrigation solution, side-end needle irrigation tip, crown-down technique application, radiographic assessment, and 0.2% chlorhexidine (CHX) as intracanal medicament. A checklist was developed and monitored to ensure that all procedures were followed. The appointment scheduling system was also improved to ensure the patient’s next visit is scheduled within 30 days. The post-intervention study showed a successful reduction of flare-up by 6%, which was further sustained at 4% and later to 5% incidence, as observed in the subsequent year. In conclusion, the intervention strategies were successful in reducing the flare-up incidence in Kangar Dental Clinic.