This study was conducted to assess caries treatment thresholds among Japanese dentists and to identify characteristics associated with their decision to intervene surgically in proximal caries lesions within the enamel. Participants (n = 189) were shown radiographic images depicting interproximal caries and asked to indicate the lesion depth at which they would surgically intervene in both high- and low-caries-risk scenarios. Differences in treatment thresholds were then assessed via chi-square tests, and associations between the decision to intervene and dentist, practice, and patient characteristics were analyzed via logistic regression. The proportion of dentists who indicated surgical intervention into enamel was significantly higher in the high-caries-risk scenario (73.8%, N = 138) than in the low-caries-risk scenario (46.5%, N = 87) (p < 0.001). In multivariate analyses for a high-caries-risk scenario, gender of dentist, city population, type of practice, conducting caries-risk assessment, and administering diet counseling were significant factors associated with surgical enamel intervention. However, for a low-caries-risk scenario, city population, type of practice, and use of a dental explorer were the factors significantly associated with surgical enamel intervention. These findings demonstrate that restorative treatment thresholds for interproximal primary caries differ by caries risk. Most participants would restore lesions within the enamel for high-caries-risk individuals.

BackgroundDental caries are largely preventable, and epidemiological evidence for a relationship between diet and oral health is abundant. To date, however, dentists’ perceptions about the role of diet and dentists’ practice patterns regarding diet counseling have not been clarified.ObjectiveThe purposes of this study were to: (1) examine discordance between dentists’ perception of the importance of diet in caries treatment planning and their actual provision of diet counseling to patients, and (2) identify dentists’ characteristics associated with their provision of diet counseling.DesignThe study used a cross-sectional study design consisting of a questionnaire survey in Japan.ParticipantsThe study queried dentists working in outpatient dental practices who were affiliated with the Dental Practice-Based Research Network Japan (JDPBRN), which aims to allow dentists to investigate research questions and share experiences and expertise (n = 282).MeasurementDentists were asked about their perceptions on the importance of diet and their practice patterns regarding diet counseling, as well as patient, practice, and dentist background data.ResultsThe majority of participants (n = 116, 63%) recognized that diet is “more important” to oral health. However, among participants who think diet is “more important” (n = 116), only 48% (n = 56) provide diet counseling to more than 20% of their patients. Multiple logistic regression analysis suggested that several variables were associated with providing diet counseling; dentist gender, practice busyness, percentage of patients interested in caries prevention, caries risk assessment, and percentage of patients who receive blood pressure screening.ConclusionsSome discordance exists between dentists’ perception of the importance of diet in caries treatment planning and their actual practice pattern regarding diet counseling to patients. Reducing this discordance may require additional dentist education, including nutritional and systemic disease concepts; patient education to increase perception of the importance of caries prevention; or removing barriers to practices’ implementation of counseling.Trial RegistrationClinicalTrials.gov NCT01680848

Objective The aims of this study were to examine dentists’ recommendations for in-office fluoride to patients, and identify dentists’ characteristics associated with these recommendations. Study Design and Setting The study was conducted using a cross-sectional questionnaire survey in Japan. The survey queried dentists (N=282) in outpatient dental practices affiliated with the Dental Practice-based Research Network Japan (JDPBRN). This network aims to assist dentists in investigating research questions and sharing their experience and expertise. Results The responses were obtained by 189 dentists (67%). Among valid response, fifty-four percent of dentists (n=98) recommend in-office fluoride to more than 50% of their patients aged 6–18 years and 15% (n=29) recommended this care to more than 50% of their patients aged over 18 years. Multiple logistic regression analysis suggested that factors associated with the percentage of patients who are recommended in-office fluoride included patient interest in caries prevention; dentist belief in the effectiveness of caries risk assessment. Conclusions Dentist practice patterns for recommending in-office fluoride vary widely. Recommendation was significantly related to having a higher percentage of patients interested in caries prevention, and to the dentist’s belief about the effectiveness of caries risk assessment. (Clinicaltrials.gov registration number NCT01680848).

Objectives 1) To quantify the importance that dentists place on caries risk factors when developing a caries treatment plan, and 2) to test the hypothesis that the ratings of importance for specific factors are significantly associated with whether or not the dentist performs caries risk assessment (CRA). Methods This study used a cross-sectional study design consisting of a questionnaire survey. The study queried dentists who worked in outpatient dental practices who were affiliated with the Dental Practice-Based Research Network Japan (JDPBRN), which seeks to engage dentists in investigating research questions and sharing experiences and expertise (n=282). Participants (n=189) were asked to rate the importance of caries risk factors when developing a caries treatment plan in both adult and pediatric patients. Results Oral hygiene status was rated as the most important risk factor when developing a treatment plan in both adult and pediatric patients, whereas the use of fluorides was rated as the least important. Results of multiple logistic regression analysis showed that the odds ratios for the decision to perform CRA in the adult patient for past caries experience and use of fluorides were 2.61 (95% confidence interval [CI]: 1.29–5.29) and 1.85 (95% CI: 1.12–3.04), respectively, whereas that for oral hygiene was 3.84 (95% CI: 1.15–12.79) and use of fluorides 1.79 (95% CI: 1.06–3.03) in the pediatric patient. Conclusions These results suggest that enhancing dentists’ concept of the importance of current use of fluorides when developing a treatment plan may increase the percentage of dentists who conduct CRA in both adult and pediatric patients (clinicaltrials.gov registration number: NCT01680848).

Aims This study quantified the practice pattern of Japanese dentists in the management of pain related to temporomandibular disorders (TMDs), and identified associations between dentist characteristics and the decision to perform occlusal adjustment for TMD-related pain. Methods A cross-sectional study was conducted consisting of a questionnaire survey of dentists affiliated with the Dental Practice-based Research Network Japan (JDPBRN) (n=148). Participants were asked how they diagnosed and treated TMD-related pain. Associations between dentist characteristics and their decision to perform occlusal adjustment were analyzed via multiple logistic regression. Results 113 clinicians responded the questionnaire for a 76% response rate. 81% of the participants (n=89) treated TMDs during the previous year. Dentists treated an average of 1.9±1.8 (SD) patients with TMD-related pain monthly. Most JDPBRN dentists used similar diagnostic protocols, including questions and examinations. The most frequent treatments were splints or mouthguards (97%), medications (85%), and self-care (69%). Fifty eight percent of the participants performed occlusal adjustment for TMD-related pain. Multiple logistic regression analysis identified two factors significantly associated with the decision to perform occlusal adjustment. Odds ratios (95%CI) were “dentist lack of confidence in curing TMD-related acute pain”, 5.60 (1.260–24.861) and “proportion of patients with severe TMD-related pain”, 0.95 (0.909–0.999). Conclusions The most common treatments for TMD-related pain were reversible treatments. However, over half of dentists performed occlusal adjustment for TMD-related pain. There was a significant association between the decision to perform occlusal adjustment and lack of therapeutic confidence. The results of this study suggest that an evidence-practice gap exists regarding occlusal adjustment for TMD-related pain.

ObjectiveThe purposes of this study were to (1) quantify dentists' practice patterns regarding caries prevention and (2) test the hypothesis that certain dentists' characteristics are associated with these practice patterns.DesignThe study used a cross-sectional study design consisting of a questionnaire survey.ParticipantsThe study queried dentists who worked in outpatient dental practices who were affiliated with the Dental Practice-Based Research Network Japan, which seeks to engage dentists in investigating research questions and sharing experiences and expertise (n=282).MeasurementDentists were asked about their practice patterns regarding caries preventive dentistry. Background data on patients, practice and dentist were also collected.Results38% of dentists (n=72) provided individualised caries prevention to more than 50% of their patients. Overall, 10% of the time in daily practice was spent on caries preventive dentistry. Dentists who provided individualised caries prevention to more than 50% of their patients spent significantly more time on preventive care and less time on removable prosthetics treatment, compared to dentists who did not provide individualised caries prevention. Additionally, they provided oral hygiene instruction, patient education, fluoride recommendations, intraoral photographs taken and diet counselling to their patients significantly more often than dentists who did not provide individualised caries prevention. Multiple logistic regression analysis suggested that the percentage of patients interested in caries prevention and the percentage of patients who received hygiene instruction, were both associated with the percentage of patients who receive individualised caries prevention.ConclusionsWe identified substantial variation in dentists' practice patterns regarding preventive dentistry. Individualised caries prevention was significantly related to provision of other preventive services and to having a higher percentage of patients interested in caries prevention, but not to the dentist's belief about the effectiveness of caries risk assessment. (Clinicaltrials.gov registration number NCT01 680 848).

Objectives This study was performed to (1) quantify dentists’ treatment thresholds for occlusal primary caries; (2) determine if patient's age affects dentists’ decisions to surgically treat these carious lesions; (3) test the hypothesis that patients’, dentists’, and practices’ characteristics are significantly associated with surgical enamel intervention. Methods The study used a cross-sectional design consisting of a questionnaire survey in Japan. This study queried dentists working in outpatient dental practices who were affiliated with the Dental Practice-Based Research Network Japan (JDPBRN), which aims to allow dentists to investigate research questions and share experiences and expertise (n=282). Participants were asked whether they would surgically intervene in a series of cases depicting occlusal caries. Each case included a photograph of an occlusal surface displaying typical characteristics of caries penetration, and written descriptions of adult and pediatric patients at high caries risk. Results In a case of a carious lesion within inner enamel, the proportion of dentists who indicated surgical intervention was significantly higher in the adult patient (48%) when compared to the pediatric patient (34%) (p< 0.01). Logistic regression analysis showed that using a dental explorer for the diagnosis of primary occlusal caries, type of practice, practice busyness, and percentage of patients who self-pay were significantly associated with dentists’ decisions to intervene surgically into the inner enamel carious lesion. Conclusions These findings demonstrate that over one-third of participants chose to intervene surgically into inner enamel carious lesions, and patients’ age affects dentists’ decisions about when to intervene surgically (clinicaltrials.gov registration number NCT01680848).

Purpose The study aims were to: (1) examine dentist practice patterns regarding treatment recommendation of dental sealants; and (2) identify characteristics associated with this recommendation. Methods The study was performed using a cross-sectional questionnaire survey (Clinicaltrials.gov registration number NCT01680848). Participants were Japanese dentists (N=282) recruited from the Dental Practice-based Research Network Japan. Three clinical photographs of the occlusal surface from a mandibular first molar were presented portraying increasing depths of cavitation in a 12-year-old patient with high caries risk. Sealants would be an appropriate treatment in all three scenarios. We asked about the treatment decision for each case. We then performed multiple logistic regression analyses to evaluate associations between the decision to recommend sealants and dentist, patient and practice characteristics. Results Responses were obtained from 189 dentists (67%). In the hypothetical scenarios, dentists' recommendations of sealants for the 12-year old patient varied from 16% to 26% across three hypothesized clinical scenarios. Multiple logistic regression analysis indicated that dentist agreement with the efficacy of assessment for caries risk showed a significant association with the percentages of patients receiving sealants. Conclusions Dentist practice patterns for sealant treatment recommendation change depending on caries severity. The dentists' recommendations of sealants for the 12-year old patient were low for all three selected scenarios, based on indications for sealants in ADA guidelines. Recommending a sealant showed a significant relationship with the dentist having a higher agreement with efficacy of caries risk assessment.