Evidence-practice gap in treatment recommendations for proximal caries among Brazilian dentists

Abstract

Little is known about how Brazilian dentists’ treatment decisions for proximal carious lesions are compared to current evidence-based recommendations, so better understanding is needed to close any potential evidence-practice gap. Objectives: This cross-sectional study aimed to quantify the evidence-practice gap about proximal carious lesions treatment and identify dentist factors associated with this evidence-practice gap. Methods: Brazilian dentists (n=214) from Araraquara, São Paulo State, “completed a questionnaire about their dentist and practice characteristics and a translated version of the “Assessment of Caries Diagnosis and Caries Treatment” from the U.S. National Dental Practice-Based Research Network. Five radiographic images of proximal carious lesions in low-risk and high-risk patient scenarios were used. Associations between treatment recommendations and lesion, dentist, and practice characteristics were tested for statistical significance (p<0.05). Results: Lesions confined to the enamel would be restored by 35% and 71% of dentists in the low-risk and high-risk patient scenarios, respectively, suggesting a substantial evidence-practice gap given that surgical intervention of enamel lesions is not consistent with current evidence. The lesion depth threshold to recommend a permanent restoration differed between the low-risk and high-risk patient scenarios (p<0.001). Specific dentist/practice characteristics (dentist gender, graduate of a public dental school, postgraduate training, use of caries risk assessment) were significantly associated with the evidence-practice gap, but the magnitude of these differences was not major Conclusion: A substantial evidence-practice gap in treatment of proximal carious lesions was found for the sample overall, even when clinical scenarios presented low-risk patients. Global strategies are needed to close this substantial evidence-practice gap.