Endodontic patients treated at a University Dental Clinic over a two-year period were studied. A total of 281 patients seen in a beginning endodontic course were analyzed to determine 1) the etiology of the pul-pal disease presenting, and 2) the signs and symptoms of pulpal disease. Results indicated that caries was the most prevalent reason for endodontic treatment. Most cases (40.6%) were asymptomatic. Lower molars were the most commonly affected and there was no significant difference in endodontic treatment distribution between males and females in the patient population studied.

 
Root canal treatment (RCT) has become a stan­ dard component of dental therapy today and can be performed on any tooth of the dental arch.
The field of endodontics has expanded in recent years. Conservative treatment with the intention of keeping the natural dentition, as well as simplifica­ tion of treatment, are the main goals. Some of the principles stated more than 30 years ago are still valid while others are still having a great role so far in successful endodontic treatment1. There are incredible strides made by clinical endodontics in the past four decades and endodontics has become a highly predictable and successful phase of dental practice2. Fear of RCT has greatly diminished and pain control is very effective. Treat­ ment techniques are becoming confined, success rates have increased enormously and a large number of specialists and well-trained general dentists are practicing endodontics in their daily practice with high success rate.2 However, this success is related to our more recent understanding of the biological basis of endodontics in the light of bacteriologic and immunologic developments that lead to proper diagnosis, total tooth isolation, adequate access, total caries removal, thorough debridement, irrigation, and complete obturation of root canal.3
Dental caries is the primary cause of endodontics despite the evident decline of caries incidence.4,5,6 Trauma, as well as other factors, are causing a high demand for endodontic therapy.4,5,7
In Saudi Arabia there is evidence that caries is prevalent in a large percentage of the population. By the age of 12, only 41.9% of children are free of caries in permanent teeth.8 A study of teeth treated for endodontics in Riyadh indicated that many of them had previously untreated caries and poor restorations with secondary caries.9.
Pulpal disease is a significant problem in Saudi Arabia. Information about the pulpally-involved dental disease in the University could serve as a pointer to this disease as a national health problem.
The purpose of this study was to evaluate the causes, signs and symptoms of endodontic cases presented in King Saud University, College of Dentistry student clinics.

 
Patients presenting for treatment at the student endodontic clinics of KSU were evaluated for etiol­ ogy and signs and symptoms of pulpal disease. A total of two hundred eighty-one (281) patients were examined and treated endodontically.
The examination was performed by students in the entry level Endodontics course under direct supervision of endodontic specialist clinical instructors. Patients were also required to fill an information sheet, indicating the chief complaint: type of pain, intensity, severity in addition to the routine dental and relevant medical histories. Clin­ ical and radiographic examinations were per­
formed in order to determine the pulpal and periapical status. Vitality tests performed included both thermal and electric pulp testings. Since this was the first clinical course in endodontics, selec­ tion of the cases were conducted according to the following criteria:

1.   Simple cases only with straight canals. Curved, calcified and difficult cases were eliminated     and referred to advanced           courses.

2.   Cases with previous conventional treatment or requiring surgical approach were not used.

After diagnosis and treatment, cases were classified according to three (3) main groups:
Group I included the tooth type according to loca­ tion. These included the upper or iower anterior, bicuspids and molars.
Group II included six (6) age categorized sub­ groups as follows: < 14, 15 to 24, 25 to 34, 35 to 44, 45 to 54, and over 55.
In Group III, the cases were categorized by gender, to determine if there was sex difference in the distribution of endodontic cases. Groups I, II, and 111 were analyzed in relation to the following vari­ ables: 1} various reasons for endodontics and 2) clinical signs and symptoms. The chi-square test was used for statistical analysis.

 
The reason for endodontic treatment covered a spectrum of factors from caries to previous failed endodontic care. The major reason for endodontic treatment was caries (52.6% of the total patients). The second major reason for endodontic treatment was trauma (17.4% of the total patients) {Table 1)
The group which had the highest number of caries-caused endodontic treatment was the 15-24 age group (37.8%). This period is peak for caries attack10 and also reflects the largest proportion of the population. There is a gradual decrease of caries-caused endodontic treatment as reflected in the 55+ years age group which accounted for 5.4% of cases treated. These latter are possibly due
to root surface caries.
Trauma as a cause for endodontic treatment was present preponderantly in the group, 15-24 years (48.9%) and also declined with age to 10.2% in the 45-54 year-age group.
There were more male patients treated for endodontics than females (Figure 1). There were only eight teeth needing endodontic treatment for periodontal reasons, and five teeth needing endodontic treatment because of mechanical exposure. For the rest of the variables the reasons for endodontics were comparable in both male and female patients (Figure 1).
The signs and symptoms of endodontic cases by age (Table 2) showed that the majority of this cate­ gory were in the 15-24 years age-group (33.9%). Acute pain was also more common in this same group. Chronic pain shifted to a slightly higher age with 34% in both 15-24 and 25-34 year age-
groups.
Sinus involvement was present in 29.2% of 35-44 years age-group indicating that the middle ages were more at risk for sinus invo!vement( Table 2). Spontaneous pain associated with endodontic problems was more common in 25-34 year-old patients. There were, however, only forty-one
cases who experienced spontaneous pain (Table 1).
Since overdentures are required by older ages,it was found that 54.1 % of the cases were 45-54 age-group, and 33.3% of them were 55 years of age and older (Table 1). The highest frequency of signs and symptoms was asymptomatic (38.3% with the male and 37.7% with female). This response matched with the high percentage of cases having necrotic pulp when different vitality tests were used. Differences between males and females, in respect of all signs and symptoms, were found not to be statistically significant (Figure 2).
Caries as the cause of endodontic treatment was more common in lower molars than any other tooth type. This was followed by upper anteriors. Upper anteriors were the most commonly affected teeth by trauma. Lower molars and upper anteriors were equally affected by spontaneous pain (Table 3). Lower molars were the teeth primarily affected by acute pain while upper anteriors had more chronic pain (Table 4).

 
The information about endodontic cases which were presented for treatment at the King Saud Uni­ versity clinic provided some insights into factors surrounding pulpal diseases in Saudi Arabia. The clinic treats a diverse and large target population. However, this study did not have a representative sample of the general population.
The result indicated that the reason for endodon­ tic treatment was primarily dental caries. The caries' attack rate for the adolescence and young adults was relatively high8 and probably rising. Trauma-related endodontic treatments were traced to the high rate of maxillofacial trauma from road traffic accidents. The twenty-four cases which resulted from overdenture reflected deliberate endodontic treatment and not the presence of pul­ pal disease. The few cases which were caused by mechanical exposure reflected the limited experi­ ence of the clinicians in this early level course.
Most cases were asymptomatic (N = 106). The most common symptom experienced for endodontic cases was acute pain. Sinus involve­ ment was primarily in the 34-45 years age-group.
The distribution by tooth type revealed that lower molars were in greatest need for endodontic treatment due to caries. This corresponds to early eruption of lower molars causing a greater risk of caries in this population. In this study there was no statistically significant associations between age, sex, tooth type and reasons for endodontic treatment (p > .05). There was also no significant association between age, sex or tooth type, and signs and symptoms of the disease.

 
An analysis of cases treated in a beginning level endodontic course at King Saud University revealed that: