To Treat or Not to Treat: A Qualitative Systematic Review and Meta‐Aggregation of General Dental Practitioners' Decisions to Perform or Avoid Endodontic Treatment

Aim To synthesise qualitative evidence on the factors influencing general dental practitioners' (GDPs) decisions to perform or avoid endodontic treatment. Methods The Joanna Briggs Institute (JBI) Manual for Evidence Synthesis guided the methodology, underpinned by the Theory of Planned Behaviour. The PICo framework was formulated to define inclusion criteria. A comprehensive search of six online databases (PubMed, Scopus, Embase, Web of Science, MEDLINE via EBSCOhost, and Google Scholar for grey literature) was conducted for articles published between January 2000 and December 2025. Two authors independently performed title and abstract screening and methodological quality appraisal, with full‐text eligibility assessment and data extraction subsequently reviewed and disagreements resolved through discussion. Only primary qualitative or mixed‐methods studies containing extractable GDP‐specific data were included. Rayyan software was used to manage screening and remove duplicates. Methodological quality was appraised using the JBI Critical Appraisal Checklist. Data were synthesised using qualitative meta‐aggregation, whereby findings were grouped into categories and further aggregated into synthesised findings. Confidence in the synthesised findings was assessed using the Confidence in Qualitative Synthesis (ConQual) approach. Results The search identified 951 records, of which 442 duplicates were removed. After screening, 23 full texts were assessed, with 18 excluded, leaving five studies that met eligibility criteria, including 87 GDPs from the United Kingdom, Sweden, and New Zealand. All studies demonstrated high methodological quality (JBI scores 8–10/10). A total of 78 qualitative findings were identified and synthesised through meta‐aggregation into seven categories, which informed three synthesised findings: (1). ‘Clinical and Psychological Dimensions of Endodontic Practice’; (2). ‘Professional Preparation, Motivation, and Learning’; and (3) ‘External and System‐Level Influences on Decision‐Making’. Overall, GDPs' decisions to perform or avoid endodontic treatment were influenced by perceived clinical complexity, psychological burden, limitations in education and clinical experience, and organisational factors such as remuneration, time constraints, and referral pathways. All synthesised findings were rated as having moderate confidence. Conclusion GDPs' engagement with endodontic treatment is shaped by a combination of clinical, psychological, educational, and organisational influences. Understanding these factors can help to inform endodontic curriculum development and continuing professional development activities for dentists.