Independent predictors of endodontic treatment preference in a mixed NHS/private UK dental practice: a cross-sectional study

To identify independent predictors of self-reported patient preference for Root Canal Treatment (RCT) versus tooth extraction in a mixed NHS/ private UK dental practice, using multivariable logistic regression to determine which demographic, cognitive-sensory, and economic factors remain independently associated with preference after simultaneous adjustment for all candidate predictors. A cross-sectional consecutive convenience sample of adult patients attending a mixed NHS/private dental practice in the East Midlands, UK (July–November 2025). Sample size was calculated a priori (95% confidence level, 5% margin of error, 50% conservative proportion; minimum n = 132; target n = 155). A 22-item questionnaire, assessed for face and content validity, was administered electronically via QR-linked Microsoft Forms ( n = 141 valid responses; 97.3% response rate). Nine predictors were examined by multivariable binary logistic regression (IBM SPSS v31): age, gender, prior information of RCT, perceived procedural pain, dental fear, aesthetic importance, trust in the dentist, and willingness to pay for RCT. Pearson chi-square and Fisher’s Exact Test (2-sided) were used for univariable screening. Of 141 valid responses (68 males [48.2%], 73 females [51.8%]), 32.6% preferred RCT and 67.4% preferred extraction. In univariable analysis, only willingness to pay was significantly associated with treatment preference (Fisher’s exact p = 0.021). The multivariable model was statistically significant (χ² (12) = 24.564, p = 0.017) with good calibration (Hosmer-Lemeshow p = 0.605), explaining 22.3% of variance (Nagelkerke R² = 0.223) and correctly classifying 70.9% of cases. Three independent predictors emerged after full adjustment: perceived procedural pain (OR = 0.335, 95% CI 0.141–0.792, p = 0.013; deterrent), prior information of RCT (OR = 2.435, 95% CI 1.066–5.563, p = 0.035; facilitator), and age: patients aged 35–44 (OR = 0.272, 95% CI 0.084–0.882, p = 0.030), 45–54 (OR = 0.280, 95% CI 0.083–0.948, p = 0.041), and 55–65 years (OR = 0.252, 95% CI 0.071–0.895, p = 0.033) were 72–75% less likely to prefer RCT than the ≥ 65 reference group. Patients aged 18–34 did not differ from the oldest cohort (≥ 65 reference group). Willingness to pay showed a non-significant trend after adjustment (OR = 8.068, p = 0.056). This pilot study provides preliminary evidence that self-reported preference for RCT versus extraction in this UK setting is independently determined by perceived procedural pain, patient knowledge, and mid-adult cohort attitudinal effects. These findings are hypothesis-generating and require replication in adequately powered multicentre samples; patient education targeting pain misconceptions and attitudinal barriers may improve tooth preservation rates in similar UK populations. These preliminary findings suggest that patient education targeting perceived procedural pain and RCT misconceptions may be particularly relevant in UK general dental practice settings. Given the exploratory nature of this pilot study and the non-significant omnibus age test, targeted age-specific clinical recommendations require confirmation in adequately powered replication studies before clinical implementation.