Restorative Treatment Thresholds for Proximal Caries in Dental PBRN

Abstract

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.

Changes in Occlusal Caries Lesion Management in France from 2002 to 2012: A Persistent Gap between Evidence and Clinical Practice

“…Questionnaire surveys investigating the restorative treatment threshold and caries management strategies (from diagnosis to treatment) among general practitioners (GPs) have become more and more popular during the last three decades and have been used in Croatia, France, Scandinavia, the USA, Japan, the Netherlands, Scotland, Australia and Chile [Baraba et al, 2010;Doméjean-Orliaguet et al, 2004;Espelid et al, 1985;Espelid et al, 2001;Gordan et al, 2009;Gordan et al, 2010;Gordan et al, 2011;Heaven et al, 2013;Kakudate et al, 2012;Mejare et al, 1999;Mileman and Espelid, 1988;Nuttall and Pitts, 1990;Riley et al, 2011;Rindal et al, 2012;Riordan et al, 1991;Ruiz et al, 2012;Sundberg et al, 2000;Tveit et al, 1999;Vidnes-Kopperud et al, 2011]. Questionnaire surveys are a useful and practical method to assess the actual caries management paradigm and how evidence-based MI preventive strategies (primary, secondary and tertiary prevention) are implemented in everyday clinical practice.…”

A novel classification system for assessment of approximal caries lesion progression in bitewing radiographs

“…33,34 For example, some clinicians would restore lesions restricted within the enamel in high-risk individuals. 35 It may, however, be dubious to base a decision of operative intervention on caries risk assessment, as evidence concerning the validity of existing methods for identifying individuals at high risk is limited. 36,6 Table 3 Intrarater agreement expressed as percentage of agreement (%) and kappa with confidence interval (CI) for the assessment of caries lesion progression of approximal surfaces (n 5 65) in bitewing radiography of adolescents Raters Agreement All surfaces assessed to present progression (5,6,7,9,10,12) a Surfaces assessed to present progression within enamel (5,6,9) a Surfaces assessed to present progression in outer half of dentine (7,10,12) Numbers refer to categories presented in Figure 1.…”

Conhecimento de cirurgiões- dentistas sobre o diagnóstico e o tratamento de lesões cervicais não cariosas: um estudo piloto em rede colaborativa

“…No caso dos estudos em rede colaborativa, existe o benefício de retorno das informações aos CDs, que devem ser alertados com relação a algumas atitudes na prática clínica. Outros estudos revelam que o tipo de prática e a forma de remuneração podem influenciar diversas decisões clínicas, como o limite para a intervenção restauradora no tratamento de lesões de cárie 25,27 . Para que se possa obter uma restauração de compósito de alto desempenho, especialmente em lesões de LCNCs, é necessário um bom isolamento da margem gengival a fim de evitar a contaminação por um provável sangramento gengival e/ou pelo fluido cervicular 28 .…”

“…Para aqueles que atuam diariamente na área clínica, pode ocorrer o envolvimento no processo de pesquisa e na formulação de questionamentos de investigação clínica que podem melhorar a saúde bucal da população e sua própria prática diária. Além disso, as RPBPOs oferecem aos pesquisadores a oportunidade de aprender mais sobre questões cotidianas que envolvem a saúde oral e interagir com profissionais da área odontológica [22][23][24][25] . Diante desse cenário, as RPBPOs têm um grande potencial de contribuição com dados para o modelo de odontologia baseada em evidências, definido pela American Dental Association como: "abordagem aos cuidados bucais que requer a integração judiciosa de: a) avaliações sistemáticas de evidências clíni-cas, cientificamente pertinentes, relativas à condição e à história médica e odontológica de pacientes; b) perícia clínica do dentista; c) necessidades e preferências do paciente" 26 .…”