Patients’ knowledge and attitudes towards endodontic treatment in Türkiye: a survey-based study

Abstract

Background

The aim of this study was to evaluate the knowledge, awareness, and experiences of patients in Türkiye regarding endodontic treatment.

Methods

This study was designed as a questionnaire-based survey. The questionnaire was prepared using Google Forms and administered on a voluntary basis. Survey questions were distributed online via social media platforms and e-mail to adult participants residing in different regions of Türkiye. However, the sample was not designed to be nationally representative of the Turkish population. Participants were asked to answer a total of 19 questions. Data from 454 completed questionnaires were analyzed statistically to assess participants’ experiences, expectations, and concerns regarding root canal treatment. A p value of less than 0.05 was considered statistically significant.

Results

Differences were observed in participants’ knowledge and awareness regarding endodontic treatment. Night pain and toothache or fracture were the most commonly reported indications for RCT. A statistically significant association was found between age group and perceptions regarding the need for RCT (p < 0.05).

Conclusions

Within the limitations of this survey-based study, differences were observed in participants’ knowledge and awareness regarding endodontic treatment. Improving public understanding may support informed decision-making and appropriate treatment-seeking behavior. Further multicenter studies are needed to confirm these findings.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-026-08191-z.

Introduction

Endodontics is a branch of dentistry that deals with the health, diseases and treatment of the pulp tissue, which consists of nerve and vascular structures of the teeth [1]. Root canal treatment (RCT) is the most important alternative to tooth extraction. It is a procedure that involves the removal of infected or inflamed pulp tissue from the root canals, followed by shaping and disinfection of the canals, and their subsequent filling with appropriate materials [2]. This treatment is a minimally invasive alternative that allows the tooth to function asymptomatically while preserving the natural tooth. Compared to more invasive and costly procedures such as tooth extraction and implant applications, RCT provides significant advantages in terms of preservation of the temporomandibular joint, continuity of the existing occlusion and integrity of the periodontal supporting tissues [3]. However, there are various prejudices and misconceptions about RCT in society. This may cause patients to be reluctant to undergo treatment and to feel anxious about the treatment process [4].

Factors such as the duration of endodontic treatment, pain that may be experienced during or after the procedure, and the risk of developing complications may negatively affect the attitude of patients towards endodontic treatment [5–8]. It is stated in the literature that many patients experience stress during planned endodontic treatment and cancel their appointments as a result of this situation [8, 9]. It has also been reported that these patients are more prone to tooth decay and tooth extraction, and have less functional teeth due to inadequate oral hygiene [4]. Progression of dental caries into the pulp tissue leads to infection and loss of pulp vitality, in which case RCT is necessary [4, 10]. However, the number of visits required for patients to complete treatment and the expected pain during and after treatment introduce serious bias into the RCT [11]. Advances in endodontic technologies have led to reduced treatment duration and post-procedural discomfort, along with increased success rates. However, patient-clinician communication has also become an important factor affecting treatment compliance and success [11].

Although there are many studies in the literature on the general oral hygiene habits and knowledge levels of participants, studies evaluating the awareness and knowledge levels specific to endodontic treatment are quite limited [5, 12, 13]. Therefore, the aim of this study is to evaluate the knowledge and awareness of patients about endodontic treatment in Türkiye. The null hypothesis of the current study is that there will be no difference in the knowledge and awareness levels of patients about endodontic treatment in Türkiye.

Materials and methods

The study protocol was approved by the Bolu Abant İzzet Baysal University Non-Interventional Research Ethics Committee (decision number: 2025/63, date: 07.03.2025) and was conducted in accordance with the Declaration of Helsinki [14]. Before participating in the survey, all participants were given detailed written information about the purpose and content of the survey, and the survey questions were displayed when the participants agreed to participate in the study. The informed consent form was obtained from all participants. Compliance with PROBE 2023 guidelines for cross-sectional studies in endodontics has been documented [15].

Sample size calculation

The relationships of independent groups were planned in the main hypotheses of the research. Similar studies that can be used in calculating the sample size were examined and the sample size calculation that gave the highest number according to the statistical methods to be applied in line with the main hypotheses was taken into account. In this study, using the G. Power-3.1.9.2 (G*Power3.1.9.2; Heinrich-Heine-University Düsseldorf, Germany) program [16], a standardized effect size of 0.1744 was calculated at a 95% confidence level (α = 0.05) from a similar study [17] yielding a theoretical power of 0.80 and a minimum sample size of 448.

Questionnaire

This study was designed as a questionnaire-based survey. The questionnaire consisted of two parts. The first part included demographic information such as age, gender, and occupation, while the second part comprised multiple-choice questions related to endodontic treatment. The questionnaire used in this study was developed based on previously published studies [17–19] that examined patients’ knowledge and perceptions regarding endodontic treatment. It was selected because of its relevance to the objectives of the present study and its prior use in similar populations. To ensure its suitability for the current study, the questionnaire was reviewed and adapted by the authors to reflect the cultural and contextual characteristics of the target population. Minor wording modifications were made to improve clarity and comprehensibility while preserving the original meaning of the items. In addition, the content validity of the questionnaire was evaluated by five endodontists, and the content validity index (CVI) was found to be 1.0, indicating excellent content validity.

The survey was disseminated online via social media platforms and e-mail to adult volunteers from different regions of Türkiye. As recruitment relied on voluntary participation through online distribution, the study sample should be considered a convenience sample rather than a nationally representative sample of the Turkish population. Participants younger than 18 years of age and those working in a dentistry-related profession were excluded from the study. Participants were asked to answer a total of 19 questions, and 454 participants completed the survey.

Statistical analysis

In this study, descriptive statistics (numbers and percentages) of the data are given. In testing the relationship between categorical variables, Pearson Chi-Square test was applied when the sample size assumption (expected value > 5) was met, and Fisher Exact Test was applied when it was not met. Multiple Chi Square test was used in the analysis of multiple choice questions. Analyses were performed in IBM SPSS 27 (IBM, Armonk, NY, USA) program. A P value below 0.05 was considered significant.

Results

The distribution of participants according to their answers to demographic and related questions is given in the Table 45.8% of the participants are in the 18–24 age range, 32.2% are in the 25–35 age range, 13.2% are in the 36–46 age range, 7.5% are in the 47–57 age range, and 1.3% are in the 58–65 age range. When gender distribution is examined, 60.4% are female and 39.6% are male. While 3.1% of the participants work in a profession related to dentistry, 96.9% do not work in this profession. While the rate of those who underwent RCT was 50.4%, the rate of those who did not undergo RCT was 49.6% (Table 1).

Table 1.

The distribution of participants according to their demographic and answers to relevant questions is shown

		n	%
Age	18–24	208	45,8
	25–35	146	32,2
	36–46	60	13,2
	47–57	34	7,5
	58–65	6	1,3
Gender	Male	180	39,6
	Female	274	60,4
Working in a dentistry-related professional group	Yes	14	3,1
	No	440	96,9
RCT experience	Yes	229	50,4
	No	225	49,6
1. Is antibiotic use alone sufficient in the treatment of endodontic infection?	Yes	32	7,0
	No	203	44,7
	Not sure	219	48,2
2. Does any toothache indicate the need for an RCT?	Yes	29	6,4
	No	345	76,0
	Not sure	80	17,6
3. Will the structure of the relevant tooth be weakened after RCT?	Yes	195	43,0
	No	99	21,8
	Not sure	160	35,2
4. Did you know that RCT is a treatment approach that includes disinfection and restoration stages for the root of the relevant tooth?	Yes	292	64,3
	No	112	24,7
	Not sure	50	11,0
5. Do you think RCT is a complex and difficult treatment approach?	Yes	306	67,4
	No	99	21,8
	Not sure	49	10,8
6. What is the source of your information about the RCT?	Dentist experience	216	47,6
	Family and friends	120	26,4
	Not sure	35	7,7
	Media and internet	83	18,3
7. In what cases do you think RCT is necessary?	In the presence of toothache or broken tooth	209	46,0
	When you have a toothache that wakes you up at night	274	60,4
	Not sure	58	12,8
	When there is a change in tooth color	117	25,8
	As a result of trauma to the teeth	118	26,0
8. What do you do when you have a toothache?	I use medicines or painkillers that I have at home	97	21,4
	I consult a dentist	329	72,5
	Not sure	28	6,2
9. Is RCT a more painful treatment than tooth extraction?	Yes	163	35,9
	No	161	35,5
	Not sure	130	28,6
10. How many visits are required to complete the RCT?	Single visit	95	20,9
	Multiple visits	218	48,0
	Not sure	141	31,1
11. Which upper restoration was applied to your RCT-treated tooth?	Permanent filling	185	40,7
	Temporary filling	46	10,1
	Crown-Bridge prosthesis	30	6,6
	I don’t know	193	42,5
12. Which of the following treatment approaches do you prefer?	RCT to save and preserve the involved tooth	382	84,1
	Extraction of the relevant tooth and replacement with an implant	28	6,2
	Not sure	44	9,7
13. Would you prefer a specialist dentist or a general practitioner for an RCT?	General practitioner	15	3,3
	Specialist dentist	387	85,2
	Not sure	52	11,5
14. Which of the following healthcare institutions would you prefer for RCT?	University Hospital	121	26,7
	Special Clinic	180	39,6
	Not sure	43	9,5
	Oral and Dental Health Center (ODHC)	110	24,2
15. Did you experience anxiety during the RCT?	Yes	200	44,1
	No	137	30,2
	Not sure	117	25,8

n: Number of participant, %: Percentage data

Only 7.0% of the participants thought that antibiotic use alone was sufficient to treat endodontic infection. 44.7% stated that it was not sufficient, while 48.2% were not sure. The proportion of participants who thought that any toothache required RCT was 6.4%, whereas 76.0% disagreed with this view. Additionally, 43.0% of the participants believed that tooth structure is weakened after RCT. 64.3% know that RCT includes disinfection and restoration stages. The rate of those who found RCT complex and difficult was 67.4%. As sources of information, 47.6% stated their dentist experience, 26.4% their family and friends, and 18.3% the media and the internet. Participants reported that RCT was necessary in cases of night pain (60.4%), toothache or fracture (46.0%), trauma (26.0%), and tooth discoloration (25.8%). Of those who have toothache, 72.5% go to the doctor, 21.4% use home remedies. 35.9% find RCT more painful than tooth extraction, and 35.5% find it less painful. The rate of those who think that the treatment requires multiple visits is 48.0%. The most common type of restoration after treatment is permanent filling with 40.7%. 42.5% of the participants do not know which restoration was made. While 84.1% of the participants preferred to preserve the tooth with RCT, 6.2% preferred implant application. While 85.2% prefer a specialist dentist for treatment, 3.3% prefer a general practitioner. 39.6% prefer private clinics, 26.7% prefer university hospitals, 24.2% prefer Oral and Dental Health Centers (ODHC). The rate of those who experience anxiety during treatment is 44.1% (Table 1).

The distributions of responses to age-related questions were given and the relationships between them were examined using Fisher’s Exact and Multiple Chi Square tests. As a result of the analysis, a statistically significant relationship was found between age groups and the question “Does any toothache indicate the need for RCT?” (p < 0.05). While 50% of participants in the 58–65 age group agree with this opinion, this rate is 4.8% in the 18–24 age group, 6.8% in the 25–35 age group and 3.3% in the 36–46 age group. The rate of participants agreeing with this opinion increases with age (Table 2).

Table 2.

The distribution of answers to questions about age and their distribution among them are presented

	Age	18–24		25–35		36–46		47–57		58–65
		n	%	n	%	n	%	n	%	n	%	Test Statistics	P value
2. Does any toothache indicate the need for an RCT?	Yes	10a	4,8	10a	6,8	2a	3,3	4a, b	11,8	3b	50,0	23,304	0,002*
	No	170a	81,7	109a	74,7	44a	73,3	21a, b	61,8	1b	16,7
	Not sure	28a	13,5	27a	18,5	14a	23,3	9a	26,5	2a	33,3
4. Did you know that RCT is a treatment approach that includes disinfection and restoration stages for the root of the relevant tooth?	Yes	145	69,7	86	58,9	37	61,7	19	55,9	5	83,3	10,157	0,224
	No	42	20,2	46	31,5	13	21,7	10	29,4	1	16,7
	Not sure	21	10,1	14	9,6	10	16,7	5	14,7	0	0,0
6. What is the source of your information about the RCT?	Dentist experience	104	50,0	66	45,2	27	45,0	17	50,0	2	33,3	9,234	0,657
	Family and friends	48	23,1	44	30,1	17	28,3	8	23,5	3	50,0
	Not sure	19	9,1	8	5,5	3	5,0	4	11,8	1	16,7
	Media and internet	37	17,8	28	19,2	13	21,7	5	14,7	0	0,0
7. In what cases do you think RCT is necessary?	In the presence of toothache or broken tooth	91	43,8	69	47,3	27	45,0	17	50,0	5	83,3	28,777**	0,092
	When you have a toothache that wakes you up at night	138	66,3	83	56,8	36	60,0	16	47,1	1	16,7
	Not sure	22	10,6	21	14,4	8	13,3	6	17,6	1	16,7
	When there is a change in tooth color	57	27,4	38	26,0	12	20,0	9	26,5	1	16,7
	Dişlere gelen bir travma sonucunda	64	30,8	36	24,7	11	18,3	4	11,8	3	50,0
8. What do you do when you have a toothache?	I use medicines or painkillers that I have at home	35	16,8	37	25,3	17	28,3	6	17,6	2	33,3	11,700	0,132
	I consult a dentist	154	74,0	103	70,5	40	66,7	28	82,4	4	66,7
	Not sure	19	9,1	6	4,1	3	5,0	0	0,0	0	0,0
13. Would you prefer a specialist dentist or a general practitioner for an RCT?	General practitioner	9	4,3	4	2,7	1	1,7	1	2,9	0	0,0	5,583	0,652
	Specialist dentist	170	81,7	125	85,6	56	93,3	30	88,2	6	100,0
	Not sure	29	13,9	17	11,6	3	5,0	3	8,8	0	0,0
14. Which of the following healthcare institutions would you prefer for RCT?	University Hospital	59	28,4	39	26,7	12	20,0	8	23,5	3	50,0	8,098	0,770
	Special Clinic	80	38,5	58	39,7	30	50,0	11	32,4	1	16,7
	Not sure	19	9,1	15	10,3	6	10,0	3	8,8	0	0,0
	Oral and Dental Health Center (ODHC)	50	24,0	34	23,3	12	20,0	12	35,3	2	33,3

n: Number of participant, %: Percentage data

*p < 0,05, ** Multiple Chi Square test and different letters indicate different column proportions

No statistically significant relationship was found between the variables “knowledge that RCT includes disinfection and restoration stages”, “source of information”, “situations in which they think RCT is necessary”, “practice behavior in case of toothache”, “preferred type of clinician” and “preferred health institution” and age groups (p > 0.05) (Table 2).

The distribution of answers to questions about gender was given and Pearson Chi Square tests were used to examine the relationships between them. As a result of the analyses, statistically significant relationships were found between gender and “preference of specialist dentist for RCT” and “experiencing anxiety during RCT” (p < 0.05). While 89.1% of women preferred a specialist dentist for RCT, this rate was 79.4% for men. In addition, 50.7% of women stated that they experienced anxiety during treatment, while this rate was 33.9% for men (Table 3). No statistically significant relationship was found between the variables of “action taken in case of toothache” and “preferred healthcare institution” and gender (p > 0.05) (Table 3).

Table 3.

The distribution of answers to questions about gender and the relationships between them are shown

	Gender	Male		Female
		n	%	n	%	Test Statistics	P Value
8. What do you do when you have a toothache?	I use medicines or painkillers that I have at home	36	20,0	61	22,3	3,918	0,141
	I consult a dentist	128	71,1	201	73,4
	Not sure	16	8,9	12	4,4
13. Would you prefer a specialist dentist or a general practitioner for an RCT?	General practitioner	8a	4,4	7a	2,6	7,998	0,018*
	Specialist dentist	143a	79,4	244b	89,1
	Not sure	29a	16,1	23b	8,4
14. Which of the following healthcare institutions would you prefer for RCT?	University Hospital	44	24,4	77	28,1	6,600	0,086
	Special Clinic	74	41,1	106	38,7
	Not sure	24	13,3	19	6,9
	Oral and Dental Health Center (ODHC)	38	21,1	72	26,3
15. Did you experience anxiety during the RCT?	Yes	61a	33,9	139b	50,7	12,594	0,002*
	No	63a	35,0	74a	27,0
	Not sure	56a	31,1	61b	22,3

n: Number of participant, %: Percentage data

*p < 0.05 and different letters indicate different column ratios

The distribution of answers to questions regarding the RCT status was given and Pearson Chi Square tests were performed to examine the relationships between them. As a result of the analyses, statistically significant relationships were found between the status of having RCT and the variables “the structure of the relevant tooth weakens after RCT”, “RCT is a complicated and difficult treatment”, “RCT is more painful than tooth extraction”, “the number of sessions required to complete RCT”, “the type of upper restoration applied” and “the preferred treatment approach” (p < 0.05) (Table 4).

Table 4.

The distribution of responses to questions about RCT experience and the relationships between them are shown

	RCT experience	Yes		No
		n	%	n	%	Test Statistics	P Value
1. Is antibiotic use alone sufficient in the treatment of endodontic infection?	Yes	20a	8,7	12a	5,3	3,136	0,208
	No	106a	46,3	97a	43,1
	Not sure	103a	45,0	116a	51,6
3. Will the structure of the relevant tooth be weakened after RCT?	Yes	109a	47,6	86b	38,2	12,176	0,002*
	No	57a	24,9	42a	18,7
	Not sure	63a	27,5	97b	43,1
5. Do you think RCT is a complex and difficult treatment approach?	Yes	153a	66,8	153a	68,0	18,126	< 0,001*
	No	63a	27,5	36b	16,0
	Not sure	13a	5,7	36b	16,0
9. Is RCT a more painful treatment than tooth extraction?	Yes	82a	35,8	81a	36,0	48,963	< 0,001*
	No	111a	48,5	50b	22,2
	Not sure	36a	15,7	94b	41,8
10. How many visits are required to complete the RCT?	Single visit	65a	28,4	30b	13,3	33,144	< 0,001*
	Multiple visits	119a	52,0	99a	44,0
	Not sure	45a	19,7	96b	42,7
11. Which upper restoration was applied to your RCT-treated tooth?	Permanent filling	142a	62,0	43b	19,1	143,065	< 0,001*
	Temporary filling	34a	14,8	12b	5,3
	Crown-Bridge prosthesis	18a	7,9	12a	5,3
	I don’t know	35a	15,3	158b	70,2
12. Which of the following treatment approaches do you prefer?	RCT to save and preserve the involved tooth	211a	92,1	171b	76,0	23,090	< 0,001*
	Extraction of the relevant tooth and replacement with an implant	9a	3,9	19b	8,4
	Not sure	9a	3,9	35b	15,6

n: Number of participant, %: Percentage data

*p < 0.05 and different letters indicate different column ratios

While 47.6% of the participants who underwent RCT thought that their dental structure weakened after treatment, this rate was 38.2% in the untreated group. While 27.5% of those who received treatment thought otherwise, 43.1% of those who did not receive treatment were not sure about this issue. 66.8% of those who received treatment considered RCT as a difficult treatment. In the untreated group, this rate was 68%. In terms of pain perception, 48.5% of those who received treatment found RCT less painful than tooth extraction, while this rate was 22.2% in the untreated group (Table 4).

When the number of visits was examined, 28.4% of those who received treatment stated that the procedure was completed in a single visit, while this rate was 13.3% in the group that did not receive treatment. It was also observed that 62% of those who had treatment had a permanent filling, while 70.2% of those who did not have treatment did not know the type of restoration. A significant difference was also found between the groups in terms of the preferred treatment approach; 92.1% of those who had RCT preferred to save the tooth, while 76% of those who did not have treatment had the same opinion. No statistically significant association was found between participants’ opinions on whether antibiotics alone are sufficient for the treatment of endodontic infection and their history of undergoing RCT (p > 0.05) (Table 4).

Discussion

Endodontics is a branch of dentistry that aims to preserve natural teeth and is rapidly advancing under the influence of technological developments [17]. RCT, one of the most commonly used endodontic treatment methods today, consists of chemomechanical preparation, three-dimensional disinfection and a leak-proof obturation stage [20]. With RCT, the form and aesthetics of the patients’ natural teeth are preserved, and the relevant teeth are able to continue their functions without symptoms [17]. However, pain is an important factor that directly affects the quality of life and is the main reason why patients need endodontic treatment. At the same time, the pain experience may also shape patients’ attitudes towards RCT [21]. In this study, the knowledge level, awareness and approach towards RCT of patients regarding endodontic treatment in Türkiye were evaluated. The data obtained showed that there was a significant difference between the knowledge level and awareness; accordingly, the null hypothesis of the study was rejected.

Pain associated with pulp necrosis or pulpitis has been reported as one of the most common indications for RCT [22], a finding consistent with the study by Reit et al. [23], in which 58% of teeth undergoing RCT were symptomatic, with symptom relief being the most frequent indication (51%), followed by asymptomatic pathology (34%), pre-prosthetic preparation (11%), and dental trauma (4%). However, advances in magnification techniques and biomaterial technologies have led to changes in the management of vital pulp conditions. While irreversible pulpitis accompanied by severe pain was previously considered an absolute indication for RCT, current evidence suggests that vital pulp therapy may be a suitable alternative in selected cases [24], indicating that not all cases of toothache necessarily require RCT. In the present study, a significant association was observed between age groups and responses to the question, “Does any toothache indicate a need for RCT?”, with agreement increasing with age. While 50% of participants in the 58–65 age group supported this view, only 4.8% of those in the 18–24 age group did so. This difference may reflect variations in awareness, previous treatment experiences, and perceptions of endodontic care, as well as the higher likelihood of asymptomatic pathology or prosthetic treatment needs in older participants, whereas more conservative and preventive treatment approaches may be preferred in younger populations.

When participants were asked about their sources of information regarding endodontic treatment, 47.6% reported dentists as their primary source, followed by family and friends (26.4%), and media and the internet (18.3%). These findings suggest that dentists play a key role in the dissemination of information in this population. In another survey conducted in Saudi Arabia by Doumani et al. [19] only 7% of participants reported media as a source of information. Similarly, Sisodia et al. [10] in India reported that 52% of patients obtained information about treatment from family and friends. These differences may reflect variations in access to information, cultural factors, and levels of trust in healthcare providers. Overall, the source of information may influence patients’ awareness and attitudes toward endodontic treatment.

In our study, 43% of the participants believed that tooth structure is weakened after RCT. In addition, 64.3% of the participants were aware that RCT includes disinfection and restoration stages. In a study conducted in India by Sisodia et al. [10], it was reported that 52% of patients had knowledge about RCT, while Habib et al. [25] in Syria reported that 25.3% of participants had no knowledge about the treatment and 21.7% had comprehensive knowledge. These differences may be related to variations in socioeconomic status, educational level, and oral health awareness among the populations studied.

When the institutions preferred to receive treatment services are examined, 39.6% of the participants prefer private clinics, 26.7% prefer university hospitals, and 24.2% prefer ODHC. Similarly, in the study conducted by Iyer et al. [17] it was stated that the majority of the participants (51.69%) preferred private clinics over public health institutions depending on the appointment duration, number of sessions and the hygiene of the clinic environment.

The literature suggests that antibiotics are not effective in preventing or relieving signs and symptoms in cases of irreversible pulpitis, symptomatic apical periodontitis, or localized acute apical abscess when adequate local debridement and drainage are provided [26, 27]. Adequate debridement and drainage of both soft and hard tissues are essential for the successful treatment of endodontic infections. In such cases, the use of antibiotics may expose the patient to unnecessary side effects and contribute to the development of antimicrobial resistance [28]. When the role of antibiotic use in RCT was questioned in our study, only 7.0% of the participants stated that antibiotics alone were sufficient, 44.7% stated that they were insufficient, and 48.2% stated that they were not sure. These results show that a large portion of the sample is aware of the importance of endodontic treatment. Antibiotics should be prescribed only in special cases where there are signs of systemic infection or when the patient requires medical prophylaxis [29]. Our findings are consistent with the study by Aldawsari et al. [30] in which only 10.9% of Saudi Arabian participants reported that antibiotics were sufficient to treat endodontic infection. In contrast to this situation, Abu-Mostafa et al. [31] reported in their study in the same country that most patients believed that antibiotics relieved toothache and that they should be taken before consulting a dentist in case of facial swelling. These differences may be due to differences in socioeconomic levels, educational status, and dental health awareness of the populations examined in the studies.

The successful performance of RCT largely depends on the experience and technical skills of the clinician [19]. This is one of the main factors that patients consider when choosing the clinician who will perform the treatment and the healthcare facility where it will be carried out. It has been emphasized in the literature that RCT is often perceived as a complex and time-consuming procedure; therefore, having the treatment performed by a specialist dentist supported by a professional team is an important criterion for patients [17]. The findings of the present study are consistent with these reports. While 85.2% of the participants preferred a specialist dentist for RCT, only 3.3% stated that they preferred a general practitioner.

When gender-based differences in preferences were examined, Doumani et al. [19] in Saudi Arabia reported that men (74%) were more likely to choose a specialist dentist than women (60%). In contrast, in the present study, 89.1% of women and 79.4% of men reported a preference for a specialist dentist. This difference may be related to the tendency of female participants to have greater awareness of oral health, more positive attitudes toward dental care, and healthier lifestyle behaviors. Previous studies have shown that women tend to engage more frequently in oral hygiene practices, use tobacco products less, and attend dental check-ups more regularly [32, 33]. However, these differences may vary depending on study design, sample size, and the ethnic, cultural, and socioeconomic characteristics of the populations studied. Therefore, demographic and sociocultural factors should be considered when interpreting these findings.

It has been reported in the literature that gender has a decisive effect on pain and anxiety levels, and especially female participants experience higher levels of pain and anxiety during treatment [34, 35]. The findings of our study also coincide with these data. According to the responses of the participants, 50.7% of women in Türkiye stated that they experienced anxiety during the RCT, while this rate was determined as 33.9% for men. However, there are also conflicting findings in the literature on this subject. In a study conducted by Perković et al. [36] it was reported that there was no statistically significant difference between dental anxiety and gender. It is thought that these differences may arise from sociocultural structures specific to the country or region where the study was conducted, sample size, methodological differences, hormonal variability, and preoperative medication protocols. Therefore, the effect of gender on dental anxiety should be considered multidimensionally and the results obtained from different studies should be interpreted by taking contextual factors into account. In addition, it is thought that biological and psychological approaches to women’s higher frequency of receiving health services and being more sensitive to pain may play a role in explaining these differences. This situation reveals the need to develop gender-focused approaches to dental anxiety.

There is no clear consensus in the literature that the mechanical properties of the tooth structure are weakened after RCT and that RCT teeth are more fragile than vital teeth [37]. In fact, it has been reported that only a 5% decrease in tooth hardness occurs after conservative endodontic access cavity preparation [38]. In our study, 47.6% of the participants who had RCT conducted thought that the tooth structure weakened after treatment. In contrast, this rate was 38.2% among participants who had not received treatment. While 27.5% of those with RCT experience disagreed with this view, 43.1% of participants without treatment experience stated that they were not sure about the issue. These differences are thought to be due to patients not being informed sufficiently before and after treatment, some participants losing their RCT-treated teeth due to vertical root fracture or iatrogenic complications, not paying attention to oral hygiene, or harmful habits (such as bruxism, biting hard objects). In addition, it is thought that participants’ awareness levels of oral health and past treatment experiences shape their perceptions of weakening of the tooth structure.

RCT is considered a technically complex and demanding procedure for both the patient and the dentist. The case difficulty rating form developed by the American Association of Endodontists classifies endodontic cases into minimal, moderate, and high difficulty levels [39]. A recent study reported that endodontic complications frequently occur during the treatment of teeth in the high difficulty category [40]. In this context, our study investigated whether RCT was a complex procedure. 66.8% of participants with RCT experience described this treatment method as difficult. This finding suggests that treatment experience may increase patients’ awareness of endodontic processes. In contrast to this situation, in the study conducted by M. Dhanalakshmi et al. [41] in India, only 33% of the participants evaluated RCT as a complex process, 21% stated the opposite, and 46% stated that they did not have knowledge on the subject. This difference can be treated by considering that it is due to cultural differences, socioeconomic conditions and diversity of past experiences. The complexity of endodontic treatment depends on many factors such as morphological variations of the root canal system, invasion of dentinal tubules by microorganisms, formation of smear layer during treatment and the necessity of preserving the structural integrity of dentin. Additionally, the goal of effectively cleaning and shaping root canals is often made difficult by anatomical obstacles [42]. All these factors make RCT a technically complex procedure.

It is widely accepted in the literature that teeth that have undergone RCT have high long-term survival rates and that preserving the natural tooth structure is more advantageous for the patient. To increase the success of endodontic treatment, it is of great importance that the primary RCT is conducted with high clinical standards. In case of failure of RCT, the first treatment option should not be extraction of the involved tooth, fixed prosthetic restoration or implant application. Options such as nonsurgical retreatment, endodontic surgical interventions, intentional reimplantation and transplantation should be considered as a priority [43]. Systematic reviews evaluating these approaches report that the relevant treatment methods offer high success and survival rates [44, 45]. In the study conducted by Aldawsari et al. [30] it was reported that 81.5% of the patients who had previously undergone RCT preferred to preserve the relevant tooth, while 18.5% preferred extraction and implant application. In patients without RCT experience, these rates were reported as 71.7% and 28.3%, respectively [30]. In our study, a significant difference was found between the groups in parallel with these findings; 92.1% of the participants in the group with RCT experience preferred to preserve the relevant tooth, while this rate was 76% in the group without RCT experience. A retrospective study comparing the success rates of single-tooth implants with RCT showed similar failure rates for both treatment options, but postoperative complications and the need for secondary intervention were higher in the implant group [46]. In light of these findings, participants appear to have a general awareness of the importance of preserving natural teeth. However, improving knowledge and awareness remains necessary, particularly among participants without prior experience of RCT.

When evaluated in terms of pain perception in our study; 48.5% of the patients who underwent RCT described this procedure as less painful than tooth extraction. On the other hand, this rate was found to be 22.2% in participants without RCT experience. These findings are partially parallel to the study by Aldawsari et al. [30]. In the study in question, 52.3% of participants with RCT experience defined RCT as more painful than tooth extraction, while this rate was 73.3% in participants without RCT experience [30]. These differences suggest that pain perception is influenced not only by physiological but also by cognitive and experiential factors. When performed by an specialist dentist, endodontic procedures can generally be completed with very little pain. In the literature, it is recommended that the clinician determine the appropriate anesthesia technique for effective pain control, ensure adequate anesthesia, and use supportive techniques if necessary. The cold test stands out as one of the most reliable methods to assess whether the relevant tooth is under adequate anesthesia [47]. Factors such as pain experienced before or during RCT treatment, hormonal factors, acute exacerbations between visits, medications used before the visit, and inadequate depth of anesthesia may have affected patients’ perception of treatment-related pain. The fact that tooth extraction is usually completed in a single visit and the pain gradually decreases afterwards may have caused those with RCT experience to evaluate the extraction as a less painful procedure. On the other hand, the lack of pre-, intra-, and postoperative pain experience in participants without RCT experience may have led to a lower rate of negative perception reported in this group. It is thought that the differences in findings between studies may be related to variables in the participants’ education level, cultural background and socioeconomic status.

The coronal restoration applied after RCT plays a critical role in the success of treatment and long-term survival of the relevant tooth [48]. RP Bukmir et al. [49] reported that the prevalence of apical periodontitis was similar (12.2%) in teeth with both adequate root fillings and adequate coronal restorations and that the prevalence of apical periodontitis was similar in teeth with only adequate root fillings and inadequate coronal restorations. This finding reveals that treatment failure is higher in cases with inadequate root filling and that the effectiveness of coronal restoration becomes significant only when evaluated together with root canal filling. On the other hand, Ray et al. [48] emphasized that a quality restoration combined with good endodontic treatment prevents the development of periapical inflammation by 91.4%. The lowest survival rates in the literature were observed in teeth without permanent restoration after RCT [50]. These data suggest that the quality of both the root canal filling and the restorative procedures have a synergistic effect on endodontic treatment outcomes. In our current study, it was determined that the most frequently preferred restoration type after treatment was permanent filling at a rate of 40.7%. However, 42.5% of the participants stated that they did not know which restoration was applied. In the subgroup analysis, it was seen that 62% of the participants who had RCT had a permanent filling, while 70.2% of the participants who did not have treatment had no information about the type of restoration. It is thought that this difference may be related to variables such as participants’ treatment experience, knowledge level, socioeconomic conditions and health literacy. In conclusion, it is clear that the long-term success of RCT depends not only on the success of endodontic procedures but also on the quality of restorative procedures and patient awareness.

When the findings in our study were evaluated regarding the number of visits required to complete RCT, 28.4% of the participants who received treatment stated that the procedure was completed in a single visit. This rate was found to be 13.3% in the group without RCT experience. Similarly, Bansal et al. [51] previously reported that 21.9% of patients who underwent an RCT completed treatment in a single visit, while 71.1% required more than one visit. Technological advances in endodontics, particularly advanced rotary instrument systems, digital imaging, and powerful irrigation techniques, have made it possible to perform single-visit RCTs in many cases. However, some clinicians prefer multi-visit treatment protocols, arguing that intracanal drug application is more effective in reducing bacterial load. It has been reported in the literature that 52.4% of dentists completed the RCT in three visits, 26.8% in a single visit, and the rate of those who applied more than three visits was quite low [52]. In our study, the fact that participants with treatment experience had a higher rate of believing that the procedure could be completed in a single visit, while participants without RCT experience had a lower rate of this opinion due to lack of knowledge on this subject, may be one of the important reasons for the difference. In addition, treatment history, the participants’ previous pain experiences, attitudes towards treatment, and the desire to avoid temporary changes in quality of life due to pain may be among the factors that increase interest in single-visit applications.

This study has several limitations that should be considered when interpreting the findings. First, due to its cross-sectional design, changes in participants’ knowledge and perceptions over time could not be evaluated, and causal relationships cannot be inferred. Second, although the minimum sample size was calculated using a power analysis based on previously published data, this does not fully eliminate limitations related to sampling strategy and representativeness. The survey was distributed online and participation was voluntary; therefore, the sample should be considered a convenience sample rather than a nationally representative sample of the Turkish population. Although participants were recruited from different regions of Türkiye, the findings reflect the responses of the study sample and may not be fully generalizable to the entire population. In addition, self-reported data may be subject to recall and response biases, and differences in educational and socioeconomic backgrounds may have influenced participants’ knowledge levels and responses. Future studies with larger, multicenter, and more representative samples are needed to confirm these findings and to provide more generalizable evidence.

This study contributes to the existing literature by providing updated insights into the knowledge, perceptions, and misconceptions of participants regarding endodontic treatment in a Turkish population. Although similar studies have been conducted in different countries, data from Türkiye remain limited. Understanding patient awareness and misconceptions is important for improving communication between clinicians and patients, supporting informed decision-making, and increasing the acceptance of endodontic treatment. From a clinical and public health perspective, the findings of this study may help guide patient education strategies and highlight the need for targeted interventions to improve oral health awareness in the community.

Conclusion

Within the limitations of this survey-based study, differences were observed in participants’ knowledge and awareness regarding endodontic treatment. While a certain level of awareness was evident, notable gaps in knowledge and potential misconceptions were also identified. These findings underscore the importance of enhancing public understanding of endodontic treatment, which may contribute to more informed decision-making, improved patient and clinician communication, and more appropriate treatment-seeking behavior. From a broader public health perspective, improving awareness and addressing misconceptions may support the preservation of natural teeth and promote better oral health outcomes at the community level. Further multicenter studies with larger and more representative samples are needed to confirm these findings and to provide more generalizable evidence.

Abbreviations

RCT

Root Canal Treatment

ODHC

Oral and Dental Health Centers

PROBE

Preferred Reporting items for Observational studies in Endodontics

CVI

Content Validity Index

Authors' contributions

MIA: Wrote the main manuscript text; İY, TÖS and İD: Prepared and edited the survey form and collected all participant data, prepared excel files for statistical analysis; MIA: Prepared the tables; All authors reviewed the article.

Funding Information

The study has no external funding.

Data availability

All data generated or analysed during this study are included in this published article [and its supplementary information files].

Declarations

Ethics approval and consent to participate

The study was conducted on a voluntary basis. All participants received detailed written information about the purpose and content of the survey before participating. The survey questions were available for viewing upon their consent to participate. The informed consent form was obtained from all participants. The study protocol was approved by the Bolu Abant İzzet Baysal University Non-Interventional Research Ethics Committee (decision number: 2025/63, date: 07.03.2025).

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.