The prognosis of treatment procedures are not only dependent on the quality of treatment rendered but also educating the patient on decision making. Patients who integrate quality of life into their treatment choices are more satisfied and experience less regret . The association between objective measures of the disease symptoms and patient perceived status of oral health has been weak [20,21]. Apart from addressing the basic treatment of symptoms and prevention of diseases while taking care of a patient, the physical, psychological, and social aspects of disease and disorders should also be addressed . Currently oral health care in dentistry focusses on the mere clinical manifestations of oral diseases and treatment of those signs or symptoms. Literature evidence supports the amelioration of pain following root canal treatment but these studies have not co-related the reduction of pain with quality of life . There’s a need for shift in focus towards rendering dental care that improves the quality of patient’s lives and to construct instruments that measure the same .
This questionnaire based survey assessed various dimensions of the individual pertaining to four major domains as previously discussed.
Sleep was affected in 80% of the patients during episodes of pain of which 98% had a significant decrease in pain after treatment. 32 patients felt that lack of sleep aggravated their pain experience the following day. Literature has enough evidence to support the unidirectional effect of sleep on future pain. Prospective studies have clearly established an association between insomnia and chronic pain,  fibromyalgia  and musculoskeletal pain . Sleep also influences variations in clinical pain on daily basis . A bidirectional association of sleep and pain with sleep being stronger predictor of pain has also been revealed in few prospective studies [27,28,29]. This implies that the magnitude of the effect is greater for the sleep to pain direction than for the reverse. Thus less sleep on a given day forecasts increased pain on the subsequent day . On the contrary, pain failed to be a prospective predictor of pain measure .
About 54% of the patients suffered from impairment of physical activity and routine chores while 98% agreed that there was a remarkable improvement in their physical activity and performance of routine chores after treatment. Studies have already proved the strong correlation between pain and its effect on physical activity including performing domestic chores, physical exercise, walk and participation in social activities [31,32,33]. 98% of patients suffered from impaired oral function like chewing and eating. This impairment was severe in 5 patients (3 females and 2 males) to the extent that they completely avoided intake of solid meals and took over to liquid diet to avoid pain aggravation due to chewing which left them acutely debilitated. These patients had a feeling of being tired and weak due to inadequate dietary intake. However all the patients (98%) agreed that their oral function improved with treatment.
The fear of impending pain had a negative impact on the psychology of the patients [80%], whereas after treatment 84% of the patients admitted that they were less conscious of the impending pain and that treatment instilled a positive attitude in the patients. 52% of the patients agreed that pain negatively impacted their mental well-being. 92% of the subjects experienced an improvement in their mental well-being after treatment with better focus on well-being of the family. 44% of the subjects had to depend on their family members for their daily routine owing to the incapacitation caused by pain. 46% of the subjects agreed that the discomfort caused by pain caused behavioural alterations towards their family members manifesting as irritability, anger or annoyance especially towards spouse or children, which created stress amidst the family members and impacted interpersonal relationships. 44% of the subjects agreed with the fact that they had to depend on their family members for their daily routine owing to the incapacitation caused by pain. Family members also felt that it was a burden for them to shoulder additional responsibilities. Some patients felt that their homefolk instilled pessimistic attitude about pain related ordeal that they may face if they resume work. This prevented them from reporting to their duties.
36% (n=27) of patients complained that there was no relief with medication before treatment but after treatment 15 out of the above 27 of patients did not feel the need to take the prescribed medication. About 34% of the patients did not feel the need to take medication after treatment as they felt that treatment alone had alleviated their pain. There were atleast seven patients in C1, five in C2 and 2 in C3 who did not perceive any difference in their quality of life before and after root canal therapy.
One major problem with the medical model of disease in analysing health behaviour: Medical model neglects the social context of the illness experience. Biomedical model gives a conceptual orientation to health status driven by the presence or absence of pathology, with a search for something to repair whereas social model of disease views illness as a social process, defined by cultural norms and mores concerning appropriate behaviour within a given social context [34,35]. Thus the idea of assessing quality of life along multiple “dimensions” implies a departure from a simple linear scale with excellent quality of life at one end and greatly diminished quality of life at the other .
The bio-psycho-social model details the doctor as an ethical practitioner who attends to the psychological aspects of the patient’s disease. He is obliged to deliver health care beyond the patient, which encompasses the family and community of the individual and emphasize prevention of disease, promotion of health and treatment of illness on equal pedestals .
It is well known that chronic pain poses adverse consequences on the family, society and health care services apart from pernicious effects on the patient’s quality of life . Acute pain conditions do have an adverse impact on the quality of life of patients according our survey.
According to a systematic review by Pak and White  comparing the prevalence of pain and its severity before, during and after root canal treatment and the consequence of root canal treatment on the magnitude of pain has been assessed. According to this review, pain reduces to an extent that it no longer impairs their quality of life. Thus enough evidence exists to substantiate the influence of root canal treatment on pain reduction. Our study focusses on how RCT and subsequent pain relief improves the QoL of patients in South India, where generally patients approach for dental treatment only when they have pain. Routine visits to dentists is not followed by many, and there is always only a need based approach to dental treatment. For those in pain however, there is a vast improvement in life style habits, social behaviour, chewing behaviour and psychology after pain reduction is accomplished.
The association between HQoL and OHRQoL have been clearly identified by Reissmann et al co-relating the OHIP-49 (Oral Health Impact Profile – 49) and SF-36 (Short form – 36) questionnaires. In our study we have designed a questionnaire which had incorporated oral pain and quality of life into a single instrument to specifically assess the influence of endodontic pain on life style of the individual. Based on the results of our study, we can conclude that oral health and general health are inseparably interlinked. Root canal treatment has a positive influence in promoting oral and general health. This is true even with patients belonging to all strata of life. Integration of quality of life measures in assessing the outcomes of root canal treatment would be a reliable factor to educate and instill a positive attitude towards the procedure. Kiyak and Reichmuth have stated that the convention that an individual requires health care and the scenario might worsen without professional help is the primary reason to seek health services . Thus strong emphasis should be laid upon reinforcing the importance of prevention amongst the general population especially in the developing countries where the burden of oral diseases exhibit an upward trend .