Treatment decision concordance for primary and secondary caries: the Dental-PBRN [presentation] Presentation uri icon

abstract

  • Objectives: To quantify concordance between individual dentists’ decisions about how to treat primary occlusal caries, primary proximal caries, and defective restorations due to secondary caries. Methods: This study engaged dentists in The Dental Practice-Based Research Network (DPBRN; www.DentalPBRN.org) in a single administration of a questionnaire to all practitioner-investigators who indicated on their Enrollment Questionnaire that they perform at least some restorative dentistry (n=901); 565 returned questionnaires. Responses from the Scandinavian region (n=57) were excluded because of certain practice differences compared to the US. Five types of hypothetical clinical scenarios were queried: primary occlusal caries; primary proximal caries; and three scenarios that queried whether existing restorations with secondary caries should be either repaired or replaced entirely. We quantified the probability that dentists who recommended restorative intervention for primary caries (occlusal and proximal) at deeper lesion depths, were the same ones who recommended that existing restorations be repaired instead of replaced entirely. Results: Dentists who recommended restorative treatment of primary occlusal caries and primary proximal caries at deeper lesion depths were significantly more likely to also recommend repair of existing restorations with secondary caries, instead of replacing the restoration entirely. Conversely, dentists who recommended restorative treatment of primary caries at shallower lesion depths were significantly more likely to also recommend replacing existing restorations entirely. These significant differences, ANOVA p<0.05, occurred for both high- and low-caries risk scenarios. The means for primary caries with respect to repairs (more,fewer) were: occlusal low (3.87,3.30), proximal low (2.93,2.38), occlusal high (3.67,2.92), proximal high (2.43,1.97). The means with respect to replacements (more,fewer) were: occlusal low (3.27,3.80), proximal low (2.26,2.80), occlusal high (2.91,3.41), proximal high (1.94,2.33). Conclusions: Dentists who recommended repairing restorations were significantly more likely to also recommend treating primary caries at a later stage (greater depth). This has implications for how best to focus interventions designed to improve routine clinical practice.