Prevalence, facilitators and barriers to patients’ decisions on root canal treatment in public dental clinics in central Malaysia: a multicentre mixed-methods study

Abstract

Root canal treatment (RCT) is a key strategy for preserving natural teeth, yet the prevalence and factors influencing RCT uptake in Malaysia are still sparse in the literature. This study aimed to determine the prevalence of RCT uptake and identify facilitators and barriers influencing patients’ decision of RCT across public dental clinics in central Malaysia. An explanatory sequential mixed-methods design was employed. Phase 1 involved clinical screening of 326 patients with teeth indicated for RCT, recruited via universal sampling across three districts with different RCT service delivery systems, and their acceptance or rejection of RCT was recorded. Phase 2 comprised 14 in-depth interviews using purposive sampling to explore facilitators and barriers, guided by the Health Belief Model (HBM). Quantitative data were analysed using descriptive statistics and logistic regressions, while qualitative data underwent thematic analysis using HBM constructs. Only 38.0% of patients accepted RCT. Older adults were less likely to accept RCT (adjusted odds ratio, aOR = 0.10; 95% confidence interval, CI: 0.03–0.36), while higher acceptance was observed among Chinese patients (aOR = 2.65; 95% CI: 1.21–5.77), those with tertiary education (aOR = 3.87; 95% CI: 2.10–7.12), patients in districts with primary dental endodontic clinics (aOR = 3.02; 95% CI: 1.33–6.90), cases involving maxillary anterior teeth (aOR = 16.13; 95% CI: 6.04–43.10), and higher clinical complexity (aOR = 7.64; 95% CI: 2.77–21.10). Decisions were influenced by perceived susceptibility and severity of symptoms and infection spread, modified by age, gender, knowledge, and socioeconomic factors. Perceived benefits included tooth preservation, function, aesthetics, and avoidance of tooth loss consequences. Perceived barriers included appointment and time constraints, accessibility, and preference for immediate pain relief. Self-efficacy was shaped by prior RCT or extraction experiences. Cues to action included dentists’ advice, social influences, and media. RCT uptake remains low across public dental clinics in central Malaysia and is influenced primarily by age, education, ethnicity, clinical, and service delivery factors. Addressing modifiable systems and communication barriers is essential to promote tooth-preserving care and support Malaysia in moving towards a healthy ageing nation.