Variability in diagnostic and therapeutic decision-making for endodontic-periodontal lesions: evidence from a cross-sectional study

Background The endodontic-periodontal lesions (EPLs) are a complex clinical condition whose diagnosis, treatment, and prognosis remain challenging. Therefore, a clear understanding of appropriate diagnostic and therapeutic approaches is essential for optimal treatment planning. This study aimed to evaluate dental practitioners' knowledge of diagnostic and therapeutic strategies for EPLs in Pakistan. Methods A cross-sectional survey was conducted among 380 registered dental practitioners in Pakistan using a self-administered questionnaire. Participants included 134 females (35.3%) and 246 males (64.7%), with the majority aged 25 – 30 years. The questionnaire assessed diagnostic, therapeutic, and prognostic knowledge of EPLs. Data were analyzed using descriptive statistics, Pearson's chi-square test, Fisher's exact test, and binary logistic regression. Results There was a substantial range in the knowledge among participants based on their demographic characteristics and profession. Unadjusted analysis showed that a statistically significant association existed between knowledge levels and independent variables, including age ( p < 0.001), professional experience ( p < 0.001), specialization ( p < 0.001), and continuing professional training ( p < 0.001); however, there was no statistically significant association found between organization type ( p = 0.076). Multivariate logistic regression analysis indicated that practitioners aged 31–35 had a greater odds ratio [adjusted odds ratio (AOR) = 1.95, 95% confidence interval (CI): 0.90–4.22; p = 0.091] of good knowledge compared to those aged 25–30. However, practitioners aged 36–40 were significantly more likely to have good knowledge (AOR = 2.99, 95% CI: 1.38 – 6.47; p = 0.005). Conclusion Practitioners had better therapeutic knowledge than diagnostic knowledge of EPLs, which indicates an overall above-average degree of awareness of EPLs, with noted gaps in diagnostic accuracy. Focused educational initiatives and evidence-based clinical practice guidelines may help improve practitioner decision-making for diagnosing EPLs as well as optimize the care provided for patients with EPLs, leading to improved patient outcomes.